ITA Gup 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.

(Minimum Credit Card Order Is $50.00 USD)

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:
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)
What is your e-mail Address?:
    Date of Birth (Month):
    Date of Birth (Day):
Date of Birth (Year):
    Your ITA Instructor's Name:
    Your Instructor's ITA Reg. Number:
    ITA School Reg. Number:
How Many Years Studying Tae Kwon Do?:
What is your current rank?:
    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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