REGISTRATION APPLICATION FORM

1)    Name:

2)    Mailing address:


3)    E-mail:

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:

Temple Arts
350 W High Street
Box 344
Lima, OH 45802
 

 






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