Name as it is to appear: ________________________________________________________

Mailing Address: _____________________________________________________________

City: _______________________________________________________________________

State: _________________________________ Zip Code: ____________________________

Country: ___________________________________________________________________

Phone: _____________________________________________________________________

E-mail/website: _______________________________________________________________

Date of Birth: ________________________________________________________________

Style: ______________________________________________________________________

Current Rank: _______________________________________________________________

Date Rank was awarded: _______________________________________________________

Name of person or organization who awarded you this rank:

___________________________________________________________________________

Rank Applied for: ____________________________________________________________

For School Charters:

Name of School as it is to appear: _________________________________________________

I am applying for:

I hereby make application for membership to Hapkido Taekwondo International. I do hereby pledge that any information I have provided to this organization about my past martial art history and all certificates provided to verify my martial art training are true and valid. Upon my acceptance, I pledge to not use my affiliation with this organization to any negative ends. If it is reported and verified that I have lied about my previously earned martial art credentials or I am misusing my association with this organization in any way, I fully understand that my affiliation with the organization and awarded certificates from the organization may be revoked.

I fully understand that Hapkido Taekwondo International is a legally registered organization. I can only use the name of this organization, in my own advertising, when I have specifically applied to do so and am granted permission by the Board of Directors in writing. I do understand, however, that I can freely display any certificates given to me by Hapkido Taekwondo International and can freely propagate the fact that I am a member and have been certified or recertifed by this organization.

I fully understand that there are many risks involved with the practice of the martial arts. In consideration for the acceptance of my application to Hapkido Taekwondo International, I hereby release this organization, its President, its Officers, and all of its members from all responsibility, all financial obligations, and all claims of liability from injury which I may receive or may give to other while in the practice of the martial arts and/or any related activities.

I certify I am above 18 years of age.

Applicants Signature: ____________________________________________ Date: _______________________________