Registration

Enter the information in the form below to complete the registration for  Dan exam December 2022.

First name *

Last name *

City *

Country *

Name club *

Name club

Address *

Postal code

Date of birth *

Place of birth *

E-mail address *

Mobile number *

SNN Passport No. *

SNN / WNA passport date *

Registration *

Exam

Re-exam

Exam *

Shodan

Nidan

Sandan

Yondan

Godan

Selection *

Freestyle

Enbu

Selection Kata *

Referee license *

Yes

Teacher license *

Yes

Kata Freestyle jury *

Yes

Self-designed kata written out (PDF) *

Name Partner 1 *

SNN Passport No. Partner 1 *

Name Partner 2

SNN Passport No. Partner 2

Name Partner 3

SNN Passport No. Partner 3

Comment

Payment Information

Amount

€

Payment Method

Betaling op dag van het evenement

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

By registering, I accept Terms and Conditions