APPLICATION FOR MEMBERSHIP Print this application and mail to WMKF HDQS!NAME: (Last)_____________________________(First)_____________________(MI)_________ ADDRESS: ____________________________________________________________________ CITY: ______________________________________STATE:______ZIP:___________________ COUNTRY:__________________________ TELEPHONE: (Home) _______________________(Fax)________________________________
DATE OF BIRTH:
____________________________AGE:_______WEIGHT:________HEIGHT:_______________ ________________________________________________________________________________________________________________________ WHY DO YOU STUDY THE MARTIAL ARTS? ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________
I hereby make application for
membership in the above mentioned organization, and upon acceptance, I
sincerely pledge to obey all rules and regulations which are set up for
the purpose of keeping the order of the federation and for the protection
of students from injury. I recognize that a risk is involved in this art,
thus requiring my adherence to these rules and regulations and to the
Instructor's discipline. FOR MINORS ONLY:
As parent or guardian of the above named applicant, I request that the
applicant be accepted and agree to hold harmless and indemnify the
organization, Master Instructor, Instructors, members and authorized
guests, of and from all claims made by or on behalf of the applicant, in
consideration of accepting him/her for entrance in this above named
organization.
MEMBERSHIP FEE:
$15.00 US$ for Color Belt, $17.00
US$ for Black Belt! |
Prof. Derman B. Hodge, Sr. P.O.BOX 13202 Florence, SC, 29504-3202 USA Phone: (843) 661-7906