Surname First Names
Address Sex
Postcode e-mail address
Date of Birth (dd/mm/yyyy)
Previous BJA Licence No Licence expiry date
Club Name

Club number        

County you wish to represent
Please select the category that best describes your ethnic group
Other (if applicable)

 

DISABILITY The Disability Discrimination Act 1995 defines a disabled person as anyone with a “physical or mental impairment that has a substantial and long term adverse effect upon his/her ability to carry out normal day to day activities.

" If you consider yourself to have a disability, please choose the description that best describes the nature of your disability and enter the code (and write in other description where appropriate) on your application

Other disability (if applicable)

 
The British Judo Association is registered under the terms of the Data Protection Act and wishes to include the information you have provided on this application on the BJA database for the purpose of administration and maintenance of membership records, provision and administration of activities, support and fund raising. Please complete the following section to indicate your consent to this process.
I consent for the information on this application form being included on the BJA Database.

BJA licence holders may subscribe to "The World of Judo" magazine at a preferential annual rate of £11.00
(usual subscription £14.50)

LICENCE CATEGORY

FEE LICENCE ONLY

FEE LICENCE + MAGAZINE
SENIOR NEW LICENCE
+16 years/issued for one year/valid for all activities

£29

£39
SENIOR RENEWAL LICENCE
+16 years/issued for one year/valid for all activities

£28

£39
SENIOR RENEWAL TWO YEAR LICENCE
+16 years/issued for two years/valid for all activities

£56

£78
JUNIOR NEW LICENCE
-16 years/issued for one year/valid for all activities

£19

£29
JUNIOR RENEWAL LICENCE
-16 years/issued for one year/valid for all activities

£18

£29
JUNIOR RENEWAL TWO YEAR LICENCE
-16 years/issued for  two years/valid for all activities

£36

£58

BJA Record Book issued free of charge with new Senior or new Junior Licence
RECREATIONAL LICENCE
+16 years/issued for one year/not valid for gradings or competitions		 £16 £27
INTRODUCTORY LICENCE (SENIOR)
+16 years/issued for 3 months
not valid for grading or competition(maximum 3 renewals allowed)		 £6 £17
INTRODUCTORY LICENCE (JUNIOR)
-16 years/issued for 3 months
not valid for grading or competition(maximum 3 renewals allowed)		 £4 £15
BJA Record Book may be purchased with Recreational or Introductory Licences £2.50  
The World of Judo Magazine ONLY £14.50 EU
£18.50 non-EU
£20.50 airmail

 
DECLARATION

I certify that to the best of my knowledge and belief, the information given in this application is correct. If accepted as a licence holder of the British Judo Association, I agree to abide by the Articles of Association and Bye-Laws together with any amendments made during the term of my licence and to comply with doping control procedures.

It is a criterion that all clubs, regions and affiliated bodies require staff, coaches, officials, administrators, parents and participants adopt and abide by the British Judo Association’s Child Protection Policy and Procedures. The document is published on the BJA web site. Hard copies can be obtained from BJA Head Office.
 
PAYMENT DETAILS Acceptable cards VISA /MASTERCARD /ACCESS /SWITCH
CREDIT/DEBIT CARD NUMBER
CARD EXPIRY DATE (mm/yy)
CARD HOLDERS NAME
I confirm that I am the authorised card holder for the credit/debit card detailed above.
ISSUE NUMBER (Switch Users Only)
Please note that we are unable to accept Solo, Electron or AMEX cards
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