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CCIKA Fall Karate Exam 2024
December 11 - 13, 2024
Dojo Name
*
CCIKA San Jose - Main Dojo
CCIKA Morgan Hill
CCIKA San Francisco
CCIKA New York
CCIKA Los Angeles
CCIKA Las Vegas
CCIKA San Diego
CCIKA Houston
CCIKA Chicago
CCIKA Washington DC
CCIKA Global
First Name
*
Last Name
*
Current Belt Color
*
White
Yellow
Orange
Green
Green/Stripe
Purple
Purple /Stripe
Brown
Brown/Stripe
Black
Belt Size
*
0
1
2
3
4
5
6
7
Class Day
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time
*
3 pm
4 pm
5 pm
6 pm
7:30 pm
Other
Address
City
State
Zip
Gender
*
Female
Male
Birth Date
*
+
Age
*
Length of Training
🛈
Rank / Kata
Not Sure?
Tykyoku Shodan
Heian Shodan
Heian Nidan
Heian Sandan
Heian Yondan
Heian Godan
Tekki Shodan
Baisai Dai
Jion
Empi
Kanku Dai
Gankaku
Hangetsu
Nijushiro Sho
Nijushiro Sho
Nijushiro Sho
Nijushiro Sho
Pre Nidan 2 - Brown - Jiin
Pre Nidan 3 - Brown - Bassai Sho
Pre Nidan 4 - Brown - Bassai Sho
Pre Nidan 5 - Brown - Kanku Sho
Pre Nidan 6 - Black - Kanku Sho
Pre Nidan 7 - Black - Tekki Nidan
Pre Nidan 8 - Black - Tekki Nidan
Pre Sandan 1 - Black - Sochin
Pre Sandan 2 - Black - Sochin
Pre Sandan 3 - Black - Sochin
Pre Sandan 4 - Black - Jitte
Pre Sandan 5 - Black - Jitte
Pre Sandan 6 - Black - Tekki Sandan
Pre Sandan 7 - Black - Tekki Sandan
Pre Sandan 8 - Black - Tekki Sandan
Pre Yondan 1 - Black - Chinte
Pre Yondan 2 - Black - Chinte
Pre Yondan 3 - Black - Meikyo
Pre Yondan 4 - Black - Meikyo
Pre Yondan 5 - Black - Meikyo
Pre Yondan 6 - Black - Gojushiro Sho
Pre Yondan 7 - Black - Gojushiro Sho
Gojushiro Sho
Godan - Black
Rokudan - Black
Email
*
Exam Fees
Exam Fee
*
$45
$40 (Elite Team Members Only)
$55 (Late fee)
Student / Adult Contact
Relationship to Participants:
*
Parent/Guardian (under 18 yrs.)
Self (18 + yrs.)
Parent/Guardian Name
*
Chief Instructor: Hanshi James Carter
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