International TaeKwon-Do Association

(International Headquarters)
P.O. Box 281, Grand Blanc, MI 48480, USA
Telephone: (810) 232-6482

Head Instructor Application

(Please Print Or Type)

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:______________

Your Present Rank:______________ Date Of Rank: Month______ Day_____ Year:________

How Many Gups At This School?__________ How Many Dans At This School?__________

I, the undersigned, do hereby apply for Head Instructor status in the ITA (International TaeKwon-Do Association™). I agree to adhere to all the rules and regulations which govern this organization and to follow the policies and procedures set forth in the ITA Constitution and By-Laws and by the Board of Directors and the President.

I am registering my School and all of my students, at this time, with the ITA and registering all those who teach at my School, as Instructors, with the ITA. I understand that under no circumstances will I be permitted to issue and/or have printed, any type of certificate or card, of rank. I further understand that all ITA Individual Applications for Membership and promotions must be presented to ITA International Headquarters and must be signed by the President and bear the ITA Official Seal.

In consideration thereof, I hereby agree that should I fail to abide by the ITA's policies, procedures, and regulations, I may be dismissed and that I shall not be entitled to a refund of any kind. I understand that all payments of any kind are non-refundable.

        ________________________________________     ____________________________
                                           Applicant's Signature                                                                   Date

First Year Head Instructor Fee: $55.00
(Annual Head Instructor Renewal Fee: $35.00)

Submit: This Application And Fee, A Photo-Copy Of Your Certificate Of Rank,
School Membership Application And Fee,
Individual Applications For Membership, For You and ALL Of Your Students
And The Fees As Indicated On The Applications.
Make All Fees Payable To ITA, In U.S. Currency.

ITA Membership Information