Please fill out the following membership application for consideration by the International Karate Association:
NOTE: Fields that are required are marked with an "*"If a required field is "Not Applicable" type "NA" in that field.
Your contact information:
*First Name *Last Name *Middle Initial *Address *City *State *Postal Code *Country Day Phone Eve Phone *Email Address *Age *Rank *Style *Years Studied
Your instructor's contact information:
Full name with ranks and titles Address City State Postal Code Country Phone Email Address
*Do you own your school? Yes No
How many schools do you own?
What type of business is it? Not a business Corporation Partnership Sole Proprietorship
*Is this to be a club or an individual membership? Club Individual
Tournament History: (Please list dates, names, places, etc.)
Please list three references not affilliated with your school.
Reference #1: First Name Last Name Middle Initial Address City State Postal Code Country Phone Email Address
Reference #2: First Name Last Name Middle Initial Address City State Postal Code Country Phone Email Address
Reference #3: First Name Last Name Middle Initial Address City State Postal Code Country Phone Email Address
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