Membership Application

 

Name:__________________________________________

Address:________________________________________

City:___________________________________________

Date of Birth:____________________________________

Email:__________________________________________

Website if any:___________________________________

Phone:_________________________________________

Rank:__________________________________________

System or Style (s):_______________________________

Instructor (s):___________________________________

Other Training:__________________________________

Brief Personal Bio and Other Comments:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How did you hear about WMAF?:______________________________________________________________

References with Phone number:

_______________________________,

_______________________________,

_______________________________,

_______________________________.

President Comments:___________________________________________________________________________________

 

WMAF BLACK BELT MEMBERSHIP $50.00 per year due by January 31st or a $10.00 late fee is added.

WMAF BLACK BELT MEMBERSHIP WITH LATE REGISTRATION $60.00

WMAF Professional Personal Webpage designed and hosted by DannyLane.Com only $99.95  See Example!

WMAF UNDER BLACK BELT MEMBERSHIP $25.00 per year.