KOREA JUNG KI HAPKIDO &
KUHAPDO of AMERICA




APPLICATION FOR MEMBERSHIP

School Name:_____________________________________________________

Address: _________________________________________________________

City: ________________ State: _____ Zip: ________ Country:_____________

Email address:__________________________ School Phone:______________

Name of Owner/Chief Instructor: _____________________________________

Style(s)______________________________        Rank:__________________

Home Address: ____________________________________________________

City: ________________ State: _____ Zip: ________ Country:_____________

Home Phone: (_____)____________ Cell Phone: (_____) ________________

Date of Birth: _______________

Please accept my application for:

Check one:

Affiliate Charter Membership_______ $300.00

Affiliate Charter Membership Renewal_______$100.00

Full Charter Membership___________$200.00

Full Charter Membership Renewal________$100.00

Individual Membership:___________$40.00

Individual Membership Renewal___________$15.00


in the Korea Jung Ki Hapkido & Kuhapdo Association of America.

I have enclosed my membership dues. I understand the benefits and privileges of this
affiliation and I pledge to comply with all KJHKAA policies.

Applicant Signature___________________________ Date_________________

Mail completed form to: Iron Eagle/Safe, Inc. PO BOX 2321 Wayne, NJ  07474
Check or money order  made payable to Iron Eagle/Safe, Inc.

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