The W.K.A.WORLD KUMDO ASSOCIATION Application For Membership (print out and mail to address below) NAME: FIRST:______________________________M:_____   LAST NAME:___________________________________ ADDRESS__________________________________________CITY_____________________STATE_____ZIP__________ COUNTRY_____________HOME PHONE: (        )____________,WORK PHONE: (      )___________,FAX(  )________________ E-MAIL:___________________________________Web_______________________________________________________ MARTIAL ART HISTORY Please include a short resume of your martial art background, including previous instructors, teaching experience and approximate dates of promotion. (Use backside of application if necessary.) CAREER INFORMATION (Yes or No) Do you presently own and operate a martial art school?_________________________________ Do you instruct at a school owned by another person? _________________________________ Do you operate a club or teach using privately owned facilities?_________________________ Do your future plans include owning and operating your own school?____________________ PERSONAL INFORMATION Age__________ Marital Status _____________ Occupation________________________________ Present Rank ____________________________ Employer _________________________________ Name of System, Style or Branch ____________ Full Time _______________________________ Certification Issued By ____________________ Part Time ________________________________ OTHER INFO:_______________________________________________________________________ Enclosed, please find my registration fee of $24.00. This fee covers the processing of my application and the subsequent issuance of my World Kumdo Association membership card. This card allows me all the privileges of association affiliation, including: semi-annual clinics, promotional examinations and charter membership discounts on the complete series of instructional video tapes. Iím also enclosing a 1 x 1 1/2 inch head photograph (color or black and white) to be used on my card. PLEASE ENROLL ME IN THE FOLLOWING MEMBERSHIP (Check all that apply) __Annual Member (Per Year)$24.00,,__Lifetime Member $250.00,,__Instructor / School Affiliate $300.00__W.K.A. Information Packet $5.00 Total Enclosed......................................$________  Signature ____________________________________________                         Date ____________________________ Send payment to:The WORLD KUM DO ASSOCIATION 1207 East Locust Street, Davenport, IA 52803 USA

Membership agreement form