Membership Application


Last Name
First Name

Birth Date (mm/dd/yy)

Address
City, State

Zipcode

Phone
(xxx-xxx-xxxx)
E-mail address
asdf

Fax
(xxx-xxx-xxxx)

Work Phone
(xxx-xxx-xxxx)
Occupation
asdf

Gi size
Shoe size

Ring size
Martial Arts Experience:

Style:
Rank:

Style:
Rank:

Style:
Rank:
Considering the following reasons for learning Martial Arts, please number them by importance to you.
1 = Least important, 5 = Most important.
Self Defense Self Confidence Self Control
Self Discipline Physicial Fitness Weight Control
How did you hear of us?

Club Dues will be $50.00 monthly with discounts given to Students and Families. All dues will be used in a non-profit manner for administration costs, equipment, etc. for the club. Any remaining funds will be used at the end of the year for a class party of some sort. Details to be discussed at the appropriate time.

As a Club Member, our goal is to provide a safe environment which inspires and transfers knowledge from the first moment you walk into the class. We hope to build true confidence through knowledge, honesty in the heart, strength in the body, friendship with one another, and a strong community. Your safety in class is of our utmost importance at all times. As a condition of acceptance into our club, the applicant herewith agrees to uphold the highest standards of quality and practice honorable and ethical principles.

It is our hope that whether you choose to train with our club or another method / style that you will continue to learn and pass the Arts on in a positive manner.
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