Membership Application Information
The following information is for the Head Instructor.
All documents will be sent to this address.
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School Name: |
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First Name: |
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Middle Initial: |
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Last Name: |
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Street Address: |
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City: |
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State: |
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Zip Code: |
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Country: |
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Phone:
(Required) |
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E-Mail Address:
(Required) |
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Date of Birth (Month): |
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Date of Birth (Day): |
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Date of Birth (Year): |
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Martial Arts Style You Are Ranked In: |
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Date of Rank (Month): |
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Date of Rank (Day): |
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Date of Rank (Year): |
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Attach Your Certificate .jpg File:(Required):
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Attach I.D. Photo Use Your Name with .jpg Extension File:(Required):
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