ITA Black Belt Membership Application
On-Line Registration Form

International TaeKwon-Do Association
P.O. Box 281
Grand Blanc,   MI   48480   USA

This On-Line Registration Form
is for those who wish to pay by CREDIT CARD.

Complete the form below and then click "Submit Application" at the bottom of this page.

When we receive a copy of your current certificate of rank, we shall review it.
Once approved, we will then charge your credit card and process your application.

Only 1st through 3rd degree black belts who are not teaching Tae Kwon Do, may apply for on-line individual membership.
If you are teaching you must register your school and students at the same time you register.
You will find the necessary applications at our website.
4th degree black belts and above may join using mail-in applications and must register a school and stduents.
Anyone 4th degree black belt or higher may not join unless he/she is teaching.

Please allow 4 to 6 weeks for processing.
(Payments are to be in U.S. Currency)

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Credit Card Holder Information

Name (As it appears on Card):
Street Address:
Zip Code:
Phone: (Required
E-Mail Address (Required)

Credit Card Information

Card Number:
    Credit Card:     Exp. Date: Month       Year:

Select Membership You Are Applying For

Membership Application Information

First Name:
Middle Initial:
Last Name:
Street Address:
Zip Code:
Phone: (Required)
    Date of Birth (Month):
    Date of Birth (Day):
Date of Birth (Year):
    Are You Teaching Tae Kwon Do?:
How Many Years Studying Tae Kwon Do?:
Attach Your Certificate .jpg File:(Required):

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