UTI Membership Application Form

U.T.I. SECURE ON-LINE
MEMBERSHIP APPLICATION
uti2007@unifiedtkd.com

        If you are applying for a
    National, State or Provincial
   representative position, please
       submit this form and send
       Martial Arts resume and
       additional information to
       Grand Master Kopperud
   gmk2007@unifiedtkd.com

If you wish, you may
CLICK HERE
to receive an INFORMATION PACKAGE by mail

Membership Application Form ( Training Manual + Poster Order Form )

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

Last Name	required
First Name	required
Middle Names	(optional)
Title	(optional)
Company	(optional)
Buyer/Parent's full Name if applicant is under 18 years
Relationship to Member
Complete Mailing Address	required
E-mail	(optional)
Website	(optional)
Home Phone	required
Work Phone	(optional)
Fax Number	(optional)
Cell Phone	(optional)
Date of Birth	Month Day Year required
Gender	required
Marital Status	required
Occupation	(optional)
Citizenship	required
Style of TKD	required Other =
Experience	years and months (optional)
Present Rank	required
Date of Present Rank	Month Day Year required
Name & Address of School or Organization	(optional)
Name & Rank of Instructor or Examiner	(optional)
Please list other Martial Arts experience and ranks attained	(optional)
If you have been sponsored by another UTI member, please include their name, rank & UTI registration no.	UTI Sponsor Name (optional) UTI Sponsor Rank (optional) UTI Sponsor Reg.No. (optional)
Please list other Martial Arts affiliations Current & Previous	(optional) I.T.F. current previous W.T.F. current previous Other current previous Other current previous

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 for
(name of geographic area)

Membership Total in U.S.Dollars: A

TRAINING MANUAL ORDER: ( full color rank-based resource manuals )
  TRAINING MANUALS: Guides for White-Belt through 3rd Dan Black-Belt
ALSO include Guides for Junior Rank Levels (ages 5-10) White to Junior Green-Belt


MANUAL COST = B-1
                         SHIPPING      =          B-2

Manual Total in U.S. Dollars: ( B1 + B2 ) B

POSTER ORDER: ( beautiful full color laminated forms posters )
   11" x 17" WALL-POSTERS: 1-Alpha, 2-Sun, 3-Earth, 4-Sky   ( 1 page each )


POSTER COST        =       C-1
                         SHIPPING     =      C-2
11" x 17" WALL-POSTERS: 5-Fire, 6-Storm, 7-Courage ( each form = 2 pages )


POSTER COST = C-3
                         SHIPPING    =     C-4

Poster Total in U.S. Dollars: ( C1 to C4 ) C

Retro-Active "Rank" Certification:
UTI Color-Belt Rank Certificates are available, upon request, and will be issued
according to the rank indicated above. Cost: $10
UTI Black-Belt rank certificates are available, upon request, and will be issued
according to the rank indicated above, upon "proof-of-rank" submitted.
"Proof-of-rank" may include: letter of recommendation from instructor, copy of rank certificate,
letter of authority, recommendation from UTI State, Provincial or National Representative.
UTI Rank Certificates are also available for "previous" lower ranks, so you may have a
COMPLETE SET if you wish. Please provide details in section D.
"Proof-of-rank" may be submitted by:
FAX: 306-934-5907 or by EMAIL. D

Other Fees/Purchases (Please Describe)

Other Fees Total in U.S.Dollars: E

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

Method of payment            required
Name on Credit Card     required
Credit Card Number            required
                                                  Month           Year
Credit Card Expiration Date required

SECURITY

Please type the following number in this boxrequired

If you would like to provide any additional information, or instructions, please do so 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.
SELECT "YES" TO AGREE: THEN CLICK "SUBMIT APPLICATION"

Membership Application Form ( Training Manual + Poster Order Form )

Send mail to uti2007@unifiedtkd.com with questions or comments about this web site. Copyright © 1997 Unified TaeKwon-Do International Revised: March 23, 2007 .

Send mail to uti2007@unifiedtkd.com with questions or comments about this web site.
Copyright © 1997 Unified TaeKwon-Do International
Revised: March 23, 2007 .