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’s Comments:___________________________________________________________________________________

BUY YEARLY MEMBERSHIP NOW WITH PAYPAL NOW!

Please forward your $50.00 yearly membership fee with this application. Once approved you will be a member in good standings and forwarded your yearly membership ID.

Renewal Membership $30.00 for all Black Belts and Ranks for 2012. Note: Previous Members can NOT advance in RANK unless you are an active member.

Approved_____________________________                                              Declined:___________________________________________