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									                                WELSH KARATE LEAGUE              Passport
                                                                   Photo
                                  WINNERS PROFILE



     Name
     DOB
     Age
     School/ college (if under 18)
     Grade
     Style
     Association
     Club Name
     Instructors Name
     Favourite Technique


         Major Titles                Year(s)              Position
        League Championships

       National Championships

       European Championships

        World Championships




Disclaimer _____________________    For under 18 years of age

  I hereby give parental consent for my son’s/daughter’s photograph and
        details to be published on The Welsh Karate League Website.

Parent’s/Guardian’s Signature _____________________ Date _______________

{please return this form to the League secretary; Mrs Mora Garside}

								
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