United States Martial Arts Institute, International

Certification and Rank Awarding Program


TAEKWONDO

BLACK BELT CERTIFICATION

APPLICATION

 
Staple

Two ID

Photos

Here

 

 

 

 


 

Personal Information

 

Name: __________________________________________________________________

Address: _________________________________________________ Apt:__________

City: ________________________________ State: ______________ ZIP:___________
Country: ________________________________________________________________
 

Date of Birth: ________month ________day ________year     Gender: __________

Home Phone: (_______)_______________ Work Phone: (_______)______________

e-mail, or website: ______________________________________________________

 

School/ Club Name: _____________________________________________________

School/ Club Address: ___________________________________________________

City: ________________________________ State: ______________ ZIP: __________

Country: ________________________________________________________________

 

Checklist

  • Rank Apply for            ______ Degree Black Belt in TAEKWONDO
  • Certification Fee        $______ Amount for your Rank Certification
  • Copy of your certificate (if required)
  • Resume
  • Brief history of personal martial arts training
  • Video tape or DVD on your personal training, or teaching, coaching, group practice, competetion, etc. (if required)
  • Make a check payable to: U.S. Martial Arts

 
Send to:    U.S. Martial Arts Institute

                              8524 Burnet Rd. #1226

                              Austin, TX 78757 USA