KOREA JUNG KI HAPKIDO &
KUHAPDO of AMERICA
APPLICATION FOR MEMBERSHIP
School Name:_____________________________________________________
Address: _________________________________________________________
City: ________________ State: _____ Zip: ________ Country:_____________
Email address:__________________________ School Phone:______________
Name of Owner/Chief Instructor: _____________________________________
Style(s)______________________________ Rank:__________________
Home Address: ____________________________________________________
City: ________________ State: _____ Zip: ________ Country:_____________
Home Phone: (_____)____________ Cell Phone: (_____) ________________
Date of Birth: _______________
Please accept my application for:
Check one:
Affiliate Charter Membership_______ $300.00
Affiliate Charter Membership Renewal_______$100.00
Full Charter Membership___________$200.00
Full Charter Membership Renewal________$100.00
Individual Membership:___________$40.00
Individual Membership Renewal___________$15.00
in the Korea Jung Ki Hapkido & Kuhapdo Association of America.
I have enclosed my membership dues. I understand the benefits and privileges of this
affiliation and I pledge to comply with all KJHKAA policies.
Applicant Signature___________________________ Date_________________
Mail completed form to: Iron Eagle/Safe, Inc. PO BOX 2321 Wayne, NJ 07474
Check or money order made payable to Iron Eagle/Safe, Inc.
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