International TaeKwon-Do Association
P.O. Box 281, Grand Blanc, MI 48480, USA
Telephone: (810) 232-6482
Individual Application For Membership
(Please Print Or Type)
Name:(Last)_________________________ First:___________________ M Initial:_______
- First-Year Membership Fees -
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.
Includes: ITA Certificate of Rank plus ITA Rank and Identification Card.
GUP (Rank Under Black Belt) = $20.00. BLACK BELT = $95.00.
Annual Renewal Fees: (Renewals receive a new Rank and Identification Card)
ITA School Members: GUP = $11.00 BLACK = $12.00
Non ITA School Members: GUP = $16.00 BLACK BELT = $25.00.
Submit: This Application, A Photo-Copy Of Your Certificate Of Rank, (Black Belts send 2 2"x2" I.D. Photos), And The First-Year
Membership Fee As Indicated On This Application.
Make All Fees Payable To ITA, In U.S. Currency.
ITA Membership Information