Date : _____________________
School / Group / Association Membership Application
Full Name_______________________________________________________________
Address_________________________________________________________________
City__________________________,State________________________,Zip__________
Country_________________,Phone__________________, Fax____________________
Email______________________________, Websitehttp://www.________________________
Name of Chief Instructor______________________________,Grade________________
Martial Art or Style___________________________________,Title________________
Number of Member Club__________, Number of Individual Members______________
Issuing Instructor____________________, Issuing Association____________________
Other
Affiliations_________________________________________________
Print and mail this Form. Please include a
photo copy of your current rank diploma and any titles
such as Rensi or Shihan, along with a brief biography of
your training.
