INDIVIDUAL APPLICATION FOR MEMBERSHIP (Please fill out neatly)
NOTE - you may print and mail this form in to the address at the bottom of this page or you may CUT AND PASTE this into your e-mail and submit it with payment in the form of a credit card (VISA, MASTERCARD, or DISCOVER), Check, or Money Order.
ALSO:
* If you wish to have your rank recognized within our organization please send copies of your rank certificates along with your membership fees.
* We can also send you information about video testing, critiquing, and instruction if you request that as well.
Date: ________
_____ Individual or Black Belt- $30.00 a year (Renewal of Membership is $20.00)
_____ School Membership - $50.00 a year (plus 2 or more students as new members from your school - school instructors, you receive a discount on students and/or black belts that you enroll, contact us for your discounted price - School Membership Renewal $40.00)
_____ * Please send me additional information to enroll my school or to start a study group
NAME:__________________________________________________________________
STREET ADDRESS (RESIDENCE):
________________________________________________________________________
________________________________________________________________________
CITY: ________________________ STATE: __________________ ZIP:______________
EVENING PHONE (_________) ______________________________________________
E-MAIL ADDRESS: ________________________________________________________
WEBSITE IF YOU HAVE ONE: ______________________________________________
BIRTH DATE: ______________________
OCCUPATION:___________________________________________________________
MARTIAL ARTS STYLE: ___________________________________________________
YEARS EXPERIENCE: _________
NAME OF INSTRUCTOR(S):
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
RANK EARNED (IF ANY): ________________________________________________________________________
Enclosed, find my annual membership fee in the amount of $30.00 (Renewal, $20) for my individual or black belt membership - $50.00 annual for school - (Renewal, $40) - please make check or money order payable to "Richard Mieir-King".
Name of School: ___________________________________________________________
For those renewing membership, please list your old membership number here: __________________________
Signature of parent (if applicant is a minor):
____________________________________________________________________
CONTACT INFO/SEND TO:
E-MAIL WITH PAYMENT TO:
OR REGULAR MAIL WITH PAYMENT TO:
UNIVERSAL FIGHTING ARTS FEDERATION
King's Studio's Supplies, and Seminars
Sifu Richard Mieir-King
4333 Ostrom Avenue
Lakewood, CA 90713-2841
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