Okinawa Uechi-ryu Family of Organizations (C) POB 217 Mount Dora, FL 32756 Tel: 321-273-0409 Fax: 352-653-3132 |
Application
form: for Affiliated Organizations This form to be faxed or mailed. |
Members
receive password to private "learning Center" website, monthly
e-mail video clip instruction tips, Reduced priced rank certificates, as earned,
from the IUKF, reduced rates at IUKF activities,
Book, Video and product discounts. |
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Affiliation: ( ) Uechi-ryu ( ) Shoheiryu ( ) Other _________________________________________________ Name
of Organization:______________________________________________________________________ City: ______________________________State__________________________Postal Code______________ Country___________________________________ Phone (______)__________________________________ Name of Organization Head:___________________________________ # of Dojo in Org:_______________ Teacher history: 1st___________________2nd___________________ 3rd_____________________________ Styles Studied:_____________________________________________________________________________ Ranks earned/style: ________________________________________________________________________ Association awarding ranks:_________________________________________________________________ Affiliations_____________________________________________________________________________________ By applying for membership, I hereby fully and unconditionally release the IUKF , its Officers and Directors, Certified Instructors and Member dojo from any and all claims for any and all injuries, accidents or losses that I may receive while practicing the martial arts sanctioned by the IUKF. Signature of Organization Head__________________________________________Date___________________
Credit card payment: Credit card type: MC__ Visa__ Name on credit card:___________________Card number: ________________________________________ Expiration date:________________________ Billing address for credit card: _____________________ City _______________State _________________ Country__________Zipcode:______________
Date Approved by IUKF______________________ IUKF Membership Number:____________________________ |