EKNGB National Referee's Course & Exam, Midlands

Date: Sunday 22nd March 2026. Address: Leicester Marriott Hotel, Smith Way, Grove Park, Leicester, LE19 1SW

Full Name * Date of Birth *

Email Address * Street Address * Town / City * Post Code * Home Telephone * Mobile Telephone *

Gender *

Male Female

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Association * Style of Karate * Karate Grade * I confirm that I hold an EKNGB Licence Slip, I know that it will be a requirement to bring my licence on the day. * EKNGB Licence Number * EKNGB Licence Issue Date * EKNGB Licence Expiry Date *

EKNGB Region *

Northern Midlands Southern

Current Kumite Qualification * Current Kata Qualification *

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EKNGB National Referee's Course Only * Select an option:EKNGB Referee Course (£50 GBP)EKNGB Referee Course (International Official's)

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EKNGB Exams * Select an option:I do not wish to take examEKNGB Kumite Exam (£40 GBP)EKNGB Kata Exam (£40 GBP)EKNGB Kata & Kumite Exam (£60 GBP)

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I confirm that I am 16yrs of age or over and hold the grade of 1st Dan or above. *

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Signature *

Date: Sunday, 8 March 2026 (EDT)

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