Page 1

Application

for Studio Membership

Global Korean Martial Arts Federation

Name of applicant

Phone number, birth date

Social security number male female

Address

E-Mail address

Occupation

part time full time

Martial arts style / current rank

Name of martial arts studio

Address of studio

Owner of the studio yes no

Martial arts styles taught by

studio

Your lineage

Instructors

Active students

Website

Page 2

Information about the studio

Remarks

Application fee $ 500.00

Credit card: Visa MasterCard American Express Discover

Credit card #: Exp. / CVC

Check # Routing # Account #

I hereby authorize my annual membership dues of $250.00 be deducted automatically on the anniversary of my

membership.

Signature of applicant/legal representive Approved by GKMAF president

Date Date

Please send with your studio logo as JPG to:

GLOBAL KOREAN MARTIAL ARTS FEDERATION, 802 MAIN ST. DICKSON CITY, PA 18519 TEL: 570-307-KICK