| ITA INSTITUTE
(Admissions and Records)
P.O. Box 281, Grand Blanc, MI 48480, USA
Telephone: (810) 232-6482
Application For Admission
(Please Print Or Type)
Name:(Last)__________________________ First:_________________ M Initial:_____
Once admitted to the Program you may submit video(s) of yourself performing the requirements for each rank when you are ready to test. Include the $25.00 Examination Fee each time you test for each Gup level, and the $115.00 Fee when testing for 1st Degree Black Belt. All fees are non-refundable and subject to change. Fees must be in U.S. Funds made payable to ITA. Mail all materials to:
Attn: Director of Admissions and Records
Post Office Box 281
Grand Blanc, Michigan 48480, U.S.A.
I hereby apply for admission to the Shim Soo Do 1st Degree Black Belt Program. I fully understand that there are no refunds for any tuition or fees. I certify that all information on this application and materials submitted are true and accurate to the best of my knowledge. I further certify that I am at least 18 years of age.
Applicant's Signature Date