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ADDRESS: CITY: STATE: ZIP: PHONE: ALL i ,IEMBERS COi 1PLETE THE FOLLOWING o MALE 0 DATE OF BIRTH: FEMALE PRESENT SCHOOL: / / HEIGHT: WEIGHT: --------------------------- CURRENT BELT COLOR: CURRENT KYU OR DAN RANK: STARTING DATE (IF WHITE BELT): PRESENT STYLE: ----------- PRESENT SENSEI: DATE OF LAST PROMOTION: ------- HIS/HERRANK: Attach copies of documents to support this outline. On a separate sheet of paper list all kata you perform and note the Sensei.

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