JKF Gojukai USA members Questionnaire
Dear current and potentially future members.

We are organizing our JKF Gojukai USA membership to more accurately project testing, record grades and, to better understand our demographics. Many existing records are missing specific data, have not yet been recorded or require updates. This new data will merge into one single file.

Please share this questionnaire with your club and affiliates to complete by October 31st 2019.  This data is not for public use. Only executive directors in Japan and the USA shall have access. Minimal personal information is required.

In regards to minors, please provide parent or guardians email address as primary contact.

You may find it helpful to have your JKF Gojukai ID cards available. Members who have lost or misplaced their cards often find this information in their email history from their grading applications or photographs of certifications. Respondents can return and edit their answers after submission.

Your cooperation and participation is greatly appreciated.

If you have not yet acquired your JKF Gojukai membership card, please email gojuryu@gmail.com for an application.
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Email *
Surname (Family name) *
Given name (First name) *
Gender *
Date of Birth (DOB) *
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Street address. *
City *
State *
Postal (zip) code *
Phone number in the USA: *
JKF Gojukai ID #: *
The sponsoring dojo of which you joined JKF Gojukai?
Approximate date you joined JKF Gojukai: *
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Your current JKF Gojukai grade: *
Do you have or know the certificate number shown on your most recent Dan grading certificate? If so, please provide.
Do you have or know the approximate date shown on your most recent JKF Gojukai Dan certificate? If so, please provide.
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Your current JKF Gojukai Shihan license: *
A copy of your responses will be emailed to the address you provided.
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