ITA Head Instructor and School
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.
(Minimum Credit Card Order is $50.00)

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

This Application will not be processed, nor your credit card charged,
until we have received Applications for all of your students.

To register all of your students online, read the ITA Students Registration Email Procedures :

Then submit the fees for your students using our:
ITA Students Regiistration Form.


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:
City:
State:
Zip Code:
Country:
Phone: (Required
E-Mail Address (Required)


Credit Card Information

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


Select Membership You Are Applying For



Head Instructor And School Membership Information

ITA Reg. Number:
First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:
Zip Code:
Country:
Phone: (Required)
Your E-mail Address: (Required)
    Date of Birth (Month):
    Date of Birth (Day):
Date of Birth (Year):
What is your current ITA rank?:
    Date of Rank (Month):
    Date of Rank (Day):
Date of Rank (Year):
Name of School (Dojang):
School Street Address:
School City:
School State:
School Zip Code:
School Country:
School Phone: (Required)
Number of Gups at This School:
Number of Black Belts at This School:
Attach Your Certificate .jpg File:(Required):
Attach I.D. Photo Use Your Name with .jpg Extension File:(Required):
 
    

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