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hapkido.org --> application forms --> school membership applications |
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School or Club Name ______________________________________________________ Mailing Address ______________________________________________________ City, State, Zip Code ______________________________________________________ Head Instructor ______________________________________________________ Home Address ______________________________________________________ City, State, Zip Code ______________________________________________________ Style/Styles Taught ______________________________________________________ Please Include the names, addresses, rank(s) and phone numbers of all instructors and Black Belts affiliated with your school on the back of this form.
1st Voting Delegate: 2nd Voting Delegate Name:_______________________________ Name:_______________________________ Address:____________________________ Address:____________________________ City:_______________________________ City:_______________________________ State, Zip:_________________________ State, Zip:_________________________ School/Club membership...................................................$25 IF YOUR APPLICATION IS NOT APPROVED, ALL MONEY WILL BE REFUNDED Send to: U.S.H.F. School/Club#________ P.O. Box 177 Date Received_______ Bloomington, IN 47402 Amount Paid_________ (812) 855-4143 Dues Expire_________ Date_________________________ Total Enclosed______________________