In-Club Trial period is defined a period no longer than 2 weeks provided to a potential

member to determine if they want to join the club.

Nakashima Dojo Judo Club

First Name *

Last Name *

Applicant's age *

19 or older

19 or under

Date of birth *

Gender *

Male

Female

Other

Phone *

Email *

Current Belt Rank

Last Dojo

Emergency Contact *

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