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Membership Application

To sign up for a UTI membership, simply fill in the following form:

* denotes required field.

Please select the location:	*
Last Name:	*
First Name:	*
Middle Names:
Occupation:
Buyer/Parent's full Name if applicant is under 18 years:
Address:	*

City:	*
Province/State:	*
Country:	*
Postal Code:	*
E-mail:	*
E-mail again:	*
Home Phone:	*
Work Phone:
Date of Birth:	*
Gender:	*
Marital Status:	*
Present Rank	*
Date of Present Rank	*
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	Membership Agreement: * Applicant realizes that there is a risk of injury involved in TaeKwon-Do training. Applicant voluntarily assumes the risk of accident, injury, damage, loss or other harm of any kind to his/her person or property as a result of participating in Unified TaeKwon-Do International training, examinations and/or seminars. Neither Unified TaeKwon-Do International, nor its officers, agents, employees, instructors, fellow members or authorized guests shall in any way be held liable for any claims, liability, demand, suit, action or other proceeding of any kind for, or any or on account of accident, injury, damage, loss or other harm of any kind sustained by applicant or to his/her property. * I, the applicant, and named parent/legal guardian, do hereby authorize Unified TaeKwon-Do International and those acting under its authority to copy, use, publish, for art, advertising, trade or any other lawful purpose whatsoever, written submissions, photographs, pictures or video recordings of me, in which I may be included in whole or in part. * I, the applicant, and named parent/legal guardian, do hereby authorize Unified TaeKwon-Do International and those acting under its authority, to release my name, rank and other pertinent information, upon request for reference, verification, and/or any other purpose within the policies and procedures of Unified TaeKwon-Do International. I, the applicant, understand, that upon my written request, my membership, affiliation or specified information on file with Unified TaeKwon-Do will be kept confidential. * I, the applicant, and named parent/legal guardian, will abide by the rules, regulations, policies and procedures of Unified TaeKwon-Do International now in force, or in the future prescribed, and further understand that Unified TaeKwon-Do International reserves the right to terminate my membership at any time. NOTE: Unified TaeKwon-Do International reserves the right to perform credibility and rank verification checks now, or at any time in the future. Unified TaeKwon-Do International memberships are considered public information unless a member expresses, in writing, the contrary. NOTE: Unified TaeKwon-Do International reserves the right to accept or reject any membership application according to its requirements, rules, regulations, policies and procedures. I agree to the terms and conditions.