Membership Application
Cost: US$30.00 Per Person, 1 year
Cost: US$55.00 Per Person, 2 years

Lifetime Membership
Cost: US$500.00 age 30 - 49
Cost: US$390.00 age 50 and up per person

PO Box 185
Richmond Hill, Ontario, Canada
L4B 4R5

E-mail : info@masterathlete.com
Tel: (905) 473-9714
Fax: (905) 473-9715

The payment process used on this form is secure.
If you wish you can fax or mail in this form.
Name:
Birthdate:
Judo Rank:
W.M.J.A. Membership #:
National Judo Assoc:
Address:
City:
Prov/State:
Postal/Zipcode:
Country:
Telephone No:
Fax No:
E-mail:
Type of Membership:
 Annual Lifetime
Renewal:
 1 year 2 years
Type of Card:
 Visa Mastercard
Name of Cardholder:
Credit Card Number:
Expiry Date: