Name:(Last)_________________________ First:___________________ M Initial:_______

Address(Street):____________________________________ City:____________________

State:____________ Zip Code:______________________ Country:___________________

Date Of Birth: Month______ Day______ Year_________ Phone: (______)______________

Instructor's Name:________________________________ Instructor's Rank:_____________

Tae Kwon Do Style:_________________________ Time In Tae Kwon Do:______________

Your Present Rank:____________ Date Of Rank: Month______ Day_____ Year:_________

I hereby make application for membership in the ITA (International TaeKwon-Do Association™), and upon acceptance, I sincerely pledge to obey all rules and regulations as set forth in the ITA Constitution and By-Laws and by the President and Board of Directors. I clearly recognize that a risk is involved in the studying of the martial arts, TaeKwon-Do, and related activities, which has been completely explained to and/or understood by me and my parents and/or guardians.

In Consideration of accepting my application for entry into the ITA, I hereby release the ITA, its President, and all members of the ITA, from all responsibilities and all claims for injuries I may receive while traveling to or from or while practicing TaeKwon-Do or any related activities, and the parents and/or guardians of the applicant hereby request that this application be accepted, and in consideration thereof, agree to indemnify and release all members of the ITA, its President, and Board of Directors, from all claims made or which may be made on behalf of the applicant, for the aforesaid consideration.

        ___________________________________     ______________________________
                                  Applicant's Signature                                                                 Date

        ___________________________________     ______________________________
                     Signature of parent or guardian if applicant                                             Date
                                   is under 18 years of age.