Seminar Application Form (may include membership application)

Are you currently a member of Unified TaeKwon-Do International?
Yes I am
No I am not. This is my membership application as well as my SEMINAR application.

U.T.I. National, Provincial & State Representative Positions:
To apply for a "Representative" Position, please send, by mail or e-mail, your
Professional and Martial Arts Resumes to UTI and CHECK here:
Application for SELECT State Provincial National for (name geographic area)

Membership Total in U.S.Dollars:     SELECT MEMBERSHIP $30.00 Associate $35.00 Black-Belt $40.00 Instructor $45.00 Chief Instructor $50.00 Master $15.00 Renewal - Associate $17.50 Renewal - Black-Belt $20.00 Renewal - Instructor $0.00  I am already a member A

SEMINAR INFORMATION:
- select a 1 to 5 day seminar event, examination event           am = morning
  or "combination seminar/examination event"                        pm = afternoon
                                  Month            Day              Year               ev  =  evening

Please provide "alternate" dates to those proposed above:

Seminar Application Fee:                                            USD  $ 50.00      B
( This fee will be deducted from the
   seminar / examination / event total. )

Other Fees/Purchases (Please Describe)

Other Fees Total in U.S.Dollars:                    C

A + B + C = Total Charge in U.S.Dollars:        TOTAL

Method of payment            REQUIRED, SELECT ONE VISA Mastercard required
Name on Credit Card         required
Credit Card Number            required
                                                  Month           Year
Credit Card Expiration Date  SELECT 01 02 03 04 05 06 07 08 09 10 11 12 SELECT 2001 2002 2003 2004 2005 2006 2007 2008 2009 required

SECURITY

Please type the following number in this boxrequired

    Please provide additional information and seminar/exam event specifications here:

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.   
By submitting this application, I do hereby apply for membership into Unified TaeKwon-Do International and certify the above information is true, accurate and complete. I authorize UTI to charge all fees to my credit card listed above.
SELECT "YES" TO AGREE: NO YES THEN CLICK "SUBMIT APPLICATION"