Membership Certification
WWW.ICTF.COM

Simply fill out the following form and press the 'Submit' button below to send us the form you have filled out. All forms will be processed upon receipt of payment.
 
 

Date:

Name:
Birth Date:
(Day/Month/Year)
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:

Occupation (Full-Time): (Part-Time):

I am Practicing:
Tae Kwon Do: I.T.F. Style: W.T.F. Style: Other:

If other please explain:
Master's Name: Dan:
Instructor's Name: Dan:
School Location:  Self Taught - using what:

Months of practice (total combined if off and on):
Level of achievement:   If unofficially please explain:

I started practicing Tae Kwon Do/Martial Arts since: (Day/Month/Year)

I still continue to practice: (Day/Month/Year)

I have stopped working out since: (Day/Month/Year)

Reason:

I would like to file under: I.C.T.F. I.C.M.A.

I am a coloured belt student (White to Red/Brown Belt):

I am a Black Belt Dan:

I am an instructor Dan:

I am an assistant instructor Dan:
Level (if under Black Belt):

The number of students I train personally is:

Upon registration, you will be sent a package of your curriculum. Please send us any information about yourself not mentioned above which you would like us to know. Remember our motto is "confidentiality". Any and all the information we receive, is strictly and carefully handled and filed. We will not give any information about anybody without the consent of the person involved. 

Please make your payments to:

ICMA/Hrair-Do-Karate Ltd.
62575 Scott Town Plaza
Surrey, B.C.
Canada, V3V 7V6
1 year $30 US 1 year and badge $45 US extra badge $15 US
Visa #: Expiry Date:
Money Order     Amount enclosed (U.S.$):

NO NEW MEMBERS UNTIL FURTHER NOTICE

Thank you for your interest

 Master Hrair

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