ITA Students 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.

Complete this form after you have emailed your new ITA students Information using the
Students Registration Email Procedures.


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)



Total Fees For All Students

Number of Gups:   x $20.00   =  
Number of DANS:   x $95.00   =  
Total Fees For All Students:


Credit Card Information

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







Head Instructor Informaiton

First Name:
Middle Initial:
Last Name:
Street Address:
City:
State:
Zip Code:
Country:
Phone: (Required)
Your E-mail Address: (Required)
 
    

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