7403 Foxwood Fair Lane Humble Texas 77338 E-Mail shihanco@aol.com APPLICATION FOR AFFILIATION WITH UNITED FEDERATION OF MARTIAL ARTS I, THE UNDERSIGNED, WISH TO APPLY FOR MEMBERSHIP IN THE UNITED FEDERATION OF MARTIAL ARTS DOJO NAME: DOJO ADDRESS NAME OF ALL INSTRUCTORS 1. RANK 2. RANK 3. RANK DATE OF BIRTH APPLICANT RANK IF ACCEPTED, I AGREE TO ABIDE BY THE CONDITIONS GOVERNINE MY CONDUCT AS A STUDENT / INSTRUCTOR AND TO FOLLOW THE RULES OF THE UNITED FEDERATION OF MARTIAL ARTS. I ENCLOSE HEREWITH CHECKS / MONEY ORDER, FOR THE SUM OF $ 25. 00 US SAID AMOUNT BEING AFFILIATION FEE FOR ONE YEAR OF MEMBERSHIP OF SAID FEDERATION. SIGNATURE OF APPLICANT(write your full name or initials) DATE PRINTED NAME PHONE NUMBER ADDRESS EMAIL DOJO APPLICATION FOR AFFILIATION NAME ADDRESS NAME OF ORGANIZATION HEAD RANK HOME ADDRESS HOME PHONE BUSINESS PHONE OCCUPATION NAME OF PRESENT INSTRUCTORS 1. 2. 3. 4. NUMBER OF BLACK BELT NUMBER OF UNDER BLACK BELT PLEASE SUBMIT 1. A Complete roster identifying all Organization Officials. Including rank and residence 2. New affiliates submit payment of $50.00 US with application. All member Schools will be subject to inspection by the Regional Director and Members of the Board of Directors. It is specifically understood that your Organization shall make every effort to obtain 100% of your total members for membership in the United Federation of Martial Arts. Please enable JavaScript for this form to work.