REGISTRATION APPLICATION FORM
2) Mailing address:
4) The rank you are registering:
5) Registration number:(Will be assigned) ______________________________
6) Training hours since being awarded your current rank:___________________
7) The name of your martial arts style:
8) The name of the martial arts school you are registering:
9) Listed on-line: Yes or No:
10) How did you hear about the association?
11) What search engine did you use to find us,Google, Facebook,Yahoo, other?
12) What search keyword did you use?
13) Referral Number:_________________________
14) Age:__________Date of Birth:(day/month/year):_________________________
15) Date of membership: (day/month/year):_______________________
16) Date of rank:(day/month/year) _____________________________
17) Date eligible for promotion: (day/month/year):___________________________
18) Registration expires:(day/month/year):___________________________
19) Date of application:(day/month/year)____________________________________
20) You Signature X) ________________________________________
Please print everything exactly like you want it to appear on your certificates.
Note: Click on "file" in the upper left corner, then click on "print preview" then click "print"
PayPal is accepted or you can mail check or money order to:
350 W High Street
Lima, OH 45802
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