ITA Black Belt Application For Promotion

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

This On-Line ITA Black Belt Application For Promotion Form
is to be used by ITA Black Belts 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.

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:
    Credit Card:     Exp. Date: Month       Year:


Black Belt Promotion Fee
Get Promotion Fee Amount From ITA Headquarters
Before Submitting This Application.
Enter Promotion Fee Amount:



Member Promotion Information

First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:
Zip Code:
Country:
Phone: (Required)
    Date of Birth (Month):
    Date of Birth (Day):
Date of Birth (Year):
    Are You Teaching Tae Kwon Do?:
Your ITA Registration Number:(Required):
How Many Years Studying Tae Kwon Do?:
What Rank Were You Promoted To?:
    Date of Rank (Month):
    Date of Rank (Day):
Date of Rank (Year):
Attach Your Certificate .jpg File:(Required):
Attach I.D. Photo Use Your Name with .jpg Extension File:(Required):
 
    

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