Membership Application

Please fill in the online membership form below  (your information will not be passed on to 3rd party companies)
(Parents of Children under 12 years, please use separate form on  webpage for the class you are joining)

For payments please  download the membership standing order form or use it to obtain banking and payment reference details to set up internet banking    (click here to download SSK_standing_order_Annual_Mship) – there is no surcharge for using paper S.O. Form

MEDICAL CONDITIONS QUESTIONNAIRE.  If you have any serious medical conditions please print and sign the
Physical Activity Readiness Questionnaire (PAR-Q).  and hand it in to your instructor before you start training.

Your Name

Parents: For children (12-18 years) Joining SSK, add YOUR details here and add them under 2nd person joining** (PARENTS of children aged 5-11 years please use separate application form on web page for children's classes)

First Name *

NOTE: boxes with red * are required.

Surname *

Personal Information

Title Mr Miss Ms Mrs Dr

Gender *

Male

Female

Occupation *

Industry Other Agriculture Armed Forces Art and Design Automotive Aviation Banking Care Services Childcare Construction Craftwork Creative Education Electrical Engineering Fashion Finance/Insurance Food Sector Hair and Beauty Health Horticultural Hospitality/Catering Housewife/husband Housing Industrial/Manufacturing IT Law Leisure Marketing/Advertising/PR Media/Journalism Medical Merchant Navy Oil Pharmaceuticals Police Force Printing Public Sector Rail Recruitment Retail Retired Service Industries Student Student-Primary School Student-Secondary School Supermarket Telecoms Trade Transport Travel and Tourism Unemployed Utilities Option 50

1st line home address *

2nd line home address

Town

Post/Zip Code *

Date of Birth (DOB) dd/mm/yyyy *

Mobile Number *

Home Telephone

Work Telephone

Email address (this will be your online user name) *

Training and Membership Options

Name of main class you want to join (Members welcome at any SSK class) * Chelmsford (Essex) London Bridge (Tokei Centre) London (Bethnal Green) London E3 SSK Sparring Class (Tokei Centre) St Clement school (students + staff only) Watford (Herts kickboxing) Watford (kids U12 only - use other form) Watford (fitness/padwork-sparring/Sanda)

2nd class you want to join (relevant for taking advantage of cheaper training payment options) Chelmsford (Essex) London Bridge (Tokei Centre) London (Bethnal Green) London E3 SSK Sparring Class (Tokei Centre) St Clement school (students + staff only) Watford (Herts kickboxing) Watford (kids U12 only use other form) Watford (fitness/padwork-sparring/Sanda)

You can change these choices at any time.

How did you hear about this class? * Google Online advert Facebook Twitter Leaflet Leaflet/poster at class venue Local shop advert Newspaper advert Introductory course Friend training in SSK Word of Mouth

Name of instructor or friend who introduced you..

Members may get discounts for introducing people

Add an extra person to your Annual Membership type (Tick relevant boxes)

Add 2nd Person (Eg Child or Partner)

Add 3rd Person (family membership)

Add 4th Person (family membership)

For multiple persons: main person above + additional person(s) details below **Guardian/parent above + child details below

2nd person NAME *

2nd Person (DOB) dd/mm/yyyy *

2nd Person NOTES (IF any)

3rd person NAME *

3rd Person (DOB) dd/mm/yyyy

3rd Person NOTES (IF any)

4th person NAME *

4th Person (DOB) dd/mm/yyyy

4th Person NOTES (IF any)

Help us understand your Goals

Fight competitively

Learn to defend myself

Keep Fit

Weight Loss

Improve Self confidence

Family Activity

Make new Friends in area

Other (please specify in Notes)

Emergency Contact Details

Their Name/Relationship E.g. Wife, Brother, Friend.

Emergency Contact Phone No.

Notes / Comments (120 characters maximum)

Payment Methods (Standing Order, Internet Banking, Debit card or Paypal )

NOTE: Selecting the RECURRING PAYMENT option using Standing Order or Internet Banking, gives you 5 years price protection from increases. (Lapsed members will be charged a £10 admin fee to rejoin).

Annual Membership type. * Individual Adult £35 Individual Child 12-18yrs (& FULLTIME student) £27 Family (2 adults 2 children) £60 Class Instructor PL5M insurance £69 Class Instructor (comm) PL5M insurance £89 Group (5+) Price £TBA Other TBA enter details in Comment box Individual Adult ID Intensive Prepaid attendee Regional grading and membership renewal £50

After clicking on submit you will receive an automatic email containing SO/BACS Banking details AND a Paypal secure window will open (select "paypal Guest" for Credit card payements) please use your preferred method of payment.*

All information held in confidence by SSK. Occasionally our instructors take photographs during classes for our website, social media pages (eg Facebook) or posters. Please tick this box if you/your child does not wish to appear in these photographs. (Children’s full names are not included with photographs, unless they won an award – we would contact you, if that occurs)

I DO NOT want me / my child(ren)s photographs used

TWO + 2 = ? *

Are you human? Please answer to stop Spam.