Seiwakai Gojuryu Karatedo USA members Questionnaire
Dear current and potentially future members.

Please share this Official Seiwakai USA questionnaire with your club and affiliates to complete by October 31st 2019. We are organizing our Seiwakai USA members data to better understand our demographics and project our future. This data is not for public use or distribution. Only senior members in Japan and the USA shall have access. Minimal personal information is required. Many existing member records are missing specific data, have not yet been recorded or require updates. We are merging this information into one single file.

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

You may find it helpful to have your Seiwakai & 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 Seiwakai Gojuryu Karatedo membership card, please email Gojuryu@gmail.com for an application.


Johnpaul Williams
Membership Chair
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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: *
Seiwakai ID #: *
Approximate date you joined Seiwakai: *
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Your current Seiwakai grade: *
Do you have or know the approximate date shown on your most recent Seiwakai Dan or Kyu grading certificate? If so, please provide.
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Your current Seiwakai Sensei or Shihan license: *
Are there any individuals or dojo whom you would recommend to join Seiwakai? Please list them below.
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