ITA Gup New Membership and Promotion Payments Registration Form

	ITA Gup New Students and Promotions On-Line Payment Form International TaeKwon-Do Association P.O. Box 281 Grand Blanc, MI 48480 USA

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

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

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Head Instructor's Name:
Head Instructor's ID Number:
Name of School:
School Registration Number:

Credit Card Holder Information (All certificates will be sent to the following address)
Name (As it appears on Card):
Street Address:
City:
State:
Zip Code:
Country:
Phone: (Required
E-Mail Address (Required)

Credit Card Information

Card Number:

CVV:

Credit Card:

Exp. Date: Month

Year:

Total Fees For All Students
Number of New Gup Members:	x $20.00 =
Number of Gup Promotions:	x $15.00 =
Total Fees For All Students:

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