2nd South Asia Open International Championship
3rd South Asia Open Winter Karate Training Camp & Seminar 2024
At
Vishramdham, S.R. Save Camping Ground
Acharya Bhise Vidyanagar, Bordi, Stn. Gholwad
Dist. Palghar, Mumbai, Maharashtra, India
Organized By
Shidokan Karate Foundation
Government Regd. Under Mumbai Public Trust Act, 1950. No. E-0013788 (THN)
Regd. Office:- 403, Raghunarayan Co-Op Housing Society Ltd, Panchayat Baudi,
Cheda Road, Saraswat Colony, Dombivli East, 421201. Thane, Mumbai, Maharashtra, India
Mo- 7001250657, 9323207445.
From. 26th December to 29th December 2024.
Shihan Affiliated By All India
Ch. Srinivas Rao World Karate Association The Shidokan Japan Headquarter
6th Dan Black Belt 世界空手道連盟士道館 B/405, Om Yamuna Madhav
Branch President India Yuan Kyokushin Kickboxing Grappling Co-Op Hsg. Society Ltd.
President South Asia
World Karate Association Veer Savarkar Road, Dombivli (E)
The Shidokan Karate Japan PARTICIPATION FORM Thane,Mumbai,Maharashtra,India.
Weight Category
Kg. To. Kg.
Please a x
Registration No
2
Date Passport size
Photograph
NAME SEX - DATE OF BIRTH
FATHER’S NAME OCCUPATION
ADDRESS
APPEARING FOR GRADING BELT TO BELT
APPEARING FOR CHAMPIONSHIP KUMITE KATA CAMP GRADING
NAME OF INSTRUCTOR
PRESENT RANK STUDENT BRANCH INSTRUCTOR BRANCH CHIEF
PHONE NO PASSPORT NO.
E-MAIL. NATIONALITY
EDUCATIONAL QUALIFICATIONS
PURPOSE OF LEARNING KARATE
PARENT’S / GUARDIAN’S / STUDENT DECLARATION
I, , Student, parent/guardian
of , have no objection
if my daughter/son/myself participates in the 2nd South Asia Open Shidokan Karate International
Championship, the 3rd South Asia Open Shidokan Karate Winter Training Camp, and the grading
organized by Shidokan Karate Foundation India. In the event of any injury, damage, fracture, or
incident, we will be responsible for it.
( Signature of Parent / Guardian ) ( Signature of Student )
