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Send to: USHF Registration No._________
P.O. Box 177 Date Recd._______________
Bloomington, IN 47401 Amt. Paid _______________
812-855-4143
APPLICATION FOR MEMBERSHIP
in the
UNITED STATES HAPKIDO FEDERATION
GENERAL INFORMATION
Name ___________________________________ Date of Birth _______________________
First MI Last Mo Day Year
Mailing Address _________________________________________________ _____________
Street Address City State Zip
Phone__________________ Work Phone________________E--Mail______________________
Area Code Number Area Code Number
Name of School Attending __________________________ Own Teach Student
Check Appropriate Box/Boxes
Address ____________________________ _______________ ______________ ___________
Street Address City State Zip
Phone _____________________ Instructor's Name _________________________________
Area Code Number First MI Last
Todays Date__________________
Mo Day Year Signature _____________________________________
BACKGROUND INFORMATION
What is your present hapkido rank? ___________________________________________
Date of rank? ____________________________
Do you presently teach hapkido? __________ _________
Yes No
If yes, give school owner's Name______________________________________________
Address___________________________________________
City______________________State______Zip__________
Phone ( )__________________________
Present Rank in any other martial art:
Rank______________Instructor__________________________
Style__________________________________________________
Rank______________Instructor__________________________
Style__________________________________________________
For and in consideration of my being accepted as a member and a participant in
the United States Hapkido Federation, I, intending to be legally bound, hereby
for myself, my heirs, executors, and administrators, waive and release any and
all rights to damages or claims I may have against the said organization, its
officers, and all its members, for injuries or rights to damages suffered by me
, directly or indirectly as a result of attending, participating in, practicing
for, traveling to or from such classes or examinations, or demonstrations, or
against the owners, organizations, or members of the gymnasium, club, school,
or place where held.
Applicant's Signature ___________________________________Date_______________
On behalf of the above minor, I hereby agree to the above conditions and join
in this release, and Contract.
Parent or Guardian Signature_____________________________Date________________
Any Physical problems at this time, Please state below:______________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
IF YOUR APPLICATION IS NOT APPROVED-ALL MONEY IS REFUNDABLE
Individual Membership dues. . . . . . . . . . . . . . $15________
Life Membership . . . . . . . . . . . . . . . . . . . $250_______
U.S.H.F. Patch . . . . . . . . . . . . . . . . . . . $5_______
Other....................................................._______
Total Enclosed . . .________
(School owners may receive financial benefits not covered in this application)