Membership Application Form

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MEMBERSHIP APPLICATION FORM
TANG SOO DO GENERAL FEDERATION MOO DUk kWAN
#240, Ssanglim-Dong, Joong-Gu, Seoul Korea | TEL. 82-2-2285-1146 | FAX. 82-2-2275-1443 | |
|
Region Name: ____________________________
Club: __________________________________
MR/MRS/MISS FULL NAME _______________________
SURNAME __________________________
ADDRESS ___________________________________________________________________________
CITY _______________STATE ___________________ ZIP_ ___________________________________
DATE OF BIRTH ___________ AGE _____ OCCUP_ATION ___________________________ SEX ______
TEL. ____________________________
EMAIL __________________________________________
1.
Have you had any practice before in martial Arts? YES/NO
P_resent Grade ______________________________________
If yes, state belt ____________________________
Association/Club Name ________________________________
2.
Do you suffer from any disease, illness or other physical or mental disorder which might be or become aggravated by
the practice of Tang Soo Do and Tae Kwon Do or which might expose you others to risk?
YES/NO (if yes, please state) ____________________________________________________________________________
3.
Have you ever been convicted of a crime of violence? YES/NO
if yes, give details ____________________________________________________________________________________
* Please enclose 4 passport sized photographs
DECLARATION 1 (FOR NEW APPLICATIONS)
I __________________________ the undersigned, wish to apply for membership in the Federation. I hereby agree to abide by the
Rules and Regulations of the Federation. I declare that to the best of my knowledge and belief, the information given in this application is correct.
Signature of Applicant
_________________________________
Date _____________________________________
DECLARATION 2 (RENEWAL OF MEMBERSHIP)
I __________________________ the undersigned, wish to apply to renew my membership in the Federation. I hereby agree to
abide by the Rules and Regulations of the Federation. I declare that to the best of my knowledge and belief, the information given in this
application is correct.
Signature of Applicant
______________________________ Federation No. _______________
Date of Expiry _____________
PART C
For junior member under 18 years old
I __________________________ the undersigned, hereby give consent toto apply for membership with the World M. D. K. General
Federation M. D. W. I declare that to the best of my knowledge and belief the information given in this application is correct.
Signature of P_arent/Guardian ______________________________
Date _________________________________
PART D
Recommendation
I __________________________ the undersigned, hereby recommend the above named to be a member of the World M. D. K. General
Federation M. D. W.
Signature of Instructor
_________________________________
Date _____________________________________
REGIONAL USE ONLY
FEDERATION USE ONLY
FEDERATION STAMP
Membership Fee __________________________
Date of Approval/Rejection ___________________
Date P_aid _______________________________
Fed. No. Issued ___________________________
Collecting Officer Name _____________________
Fed. No. ________________________________
Secretary General Signature __________________
IMPORTANT: If you change your address or Telephone number, Please let us know immediately in writing to the Secretary General. K. W. Chong
Direct. 010-6279,7807 |

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