PKA Licence Application Renewal Form

P.K.A. Licence Details – IMPORTANT.

Please note that it is a condition of membership of the PKA that all who practice kickboxing at a PKA club should take out a PKA licence immediately. This is compulsory; however the first year’s cover is usually included within your membership fee.

In the unlikely event of an accident or injury sustained whilst engaging in martial arts activities, it is good to have peace of mind by having this insurance cover with a reputable insurance company. Also, your grading’s and courses are only validated when you have them recorded in your licence.

If you practice martial arts at a PKA club, your PKA licence is very important. If you have not got a licence at present or if your current licence is due for renewal, then please apply using this form immediately.

Yours in Martial Arts

Mike Haig.
PKA Principal.

APPLICATION FOR P.K.A LICENCE

Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Marital Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Occupation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Home Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Mobile Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Business Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Coach {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Club {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Expiry Date of Last Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

This date should be shown in your Red PKA book. If unsure please leave blank and we will update from our membership database.

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Signed Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

The information you provide in this form will be used solely for dealing with you as a member a PKA Kickboxing Club. This club has a Data Privacy Policy which can be found at www.kickboxuk.com/gdpr-policy.html. Your data will be stored and used in accordance with this Policy.

Please note delayed renewals will be back dated to the expiry of your previous policy.

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Discount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Need a replacement RED BOOK {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{ binding displayValue, mode=oneTime }

Please only tick Yes if you have lost your red book and therefore need a replacement book.

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{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}	---

{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}

PKA Licence Application Renewal Form

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{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

P.K.A. Licence Details – IMPORTANT.

Yours in Martial Arts

Mike Haig.
PKA Principal.

APPLICATION FOR P.K.A LICENCE

Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Marital Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Occupation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mobile Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Coach {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Club {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Expiry Date of Last Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Signed Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please note delayed renewals will be back dated to the expiry of your previous policy.

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Discount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Need a replacement RED BOOK {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PKA Licence Application Renewal Form

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

P.K.A. Licence Details – IMPORTANT.

Yours in Martial Arts

Mike Haig.
PKA Principal.

APPLICATION FOR P.K.A LICENCE

Student Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Marital Status {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Occupation {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Mobile Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Business Tel {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Coach {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Club {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Expiry Date of Last Licence {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Signed Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please note delayed renewals will be back dated to the expiry of your previous policy.

Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Discount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Need a replacement RED BOOK {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PKA Licence Application Renewal Form

APPLICATION FOR P.K.A LICENCE

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PKA Licence Application Renewal Form

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APPLICATION FOR P.K.A LICENCE

PKA Licence Application Renewal Form

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APPLICATION FOR P.K.A LICENCE