Membership Application Application Date* Date Format: DD slash MM slash YYYY Name First Last Your Date of Birth*After selecting your date of birth, please double check the year. Date Format: DD slash MM slash YYYY Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code PhoneEmail* Enter Email Confirm Email Training Location*Please choose your training location. All other applications will be processed as soon as possibleSaskatchewan (Prince Albert & La Ronge)Ontario (Toronto)Alberta (Calgary)I confirm that I have a clean criminal record.*All members are required to have a clear criminal record. If you are unsure, please contact your local Police Department or the RCMP.UnsureNoYesTraining DisclaimerPlease note that Meifu Shinkage Ryu Canada™ as well as any person involved with Taka Budo Dokokai Martial Arts Inc. cannot be held liable for injury, permanent condition, death, and/or financial hardship to yourself and/or family members and/or relatives. Training occurs at your own risk. All members attest to having sufficient medical insurance as well as liability insurance to cover any damages to self or others as a result of training with Meifu Shinkage Ryu Canada™I agree with the above training disclaimer**YesNo This iframe contains the logic required to handle Ajax powered Gravity Forms.