1999Membership Application
To join print out this form on your printer and mail to:
Please include MONEY ORDER made payable to"Combat Dynamics"
Money orders recieved, shipped same day.
If paying by personal check, allow 7 daysfor check to clear before shipment.
You will receive a JKD and White Tiger KempoCertificate of Membership suitable for framing and display inaddition to newsletter subscription.
NOTE: Black Belt Membership is$75.00 all others are $50.00. Send in copies of rankcertificates. Black Belts will receive special black beltcertifcation.
Please Print
| Name of Applicant | ______________________________________ |
| Address | ______________________________________ |
| City/State/Zip | ______________________________________ |
| Telephone | ______________________________________ |
| Date of Birth | ______________________________________ |
| Present Rank | ______________________________________ |
| Length of time in Martial Arts | ______________________________________ |
| Name of Dojo | ______________________________________ |
| Telephone (Dojo) | ______________________________________ |
| Style/System | ______________________________________ |
| Address (Dojo) | ______________________________________ |
| City/State/Zip (Dojo) | ______________________________________ |
| Instructor's Name | ______________________________________ |
| What are your reasons for joining CDIMAA | ______________________________________ |
| ______________________________________ | |
| ______________________________________ |