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North American Martial Arts Federation


Date _________________

First Name _________ Last Name ____________________________

Address ___________________________________________

City__________________________State ___ Zip Code ____________

Male __________ Female ____________ DOB ___/___/______

Current Rank _____________ Phone Number: ________________

E-Mail Address: ________________________

This application is for one of the following: Plese check below.

___Gup Membership: $45 one time fee.

___Gup Life Time Membership Fee $195

___Dan Membership: first year $45. Renewable

___I am paying my Black Belt (Dan) Annual fee of $45 Due by January 15, of each year.

___Black Belt Testing fee $195.00 + ($45 Annual Dan Fee)

This application may be faxed to the following number: 561-482-1896

Credit Card Number: __________________________________________ Exp. Date ______________

Total $_____________

Make Checks payable to North American Tang Soo Do Federation

11435A Palmetto Park Rd.

Boca Raton, FL 33428

For Information call 561-482-9049

Parents Signature (if under 18 years of age) _________________________________