INDIVIDUAL MEMBERSHIP FORM

If you would prefer, download and fill out the application HERE

Name*

First Last

Gender*

Male
Female

Birth Date*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Enter Email Confirm Email

Present Rank Information

Choose one*

Color Belt
Black Belt

Date Rank Recieved*

Present Rank Instructor Information

Instructor Name*

First Last

Instructor Rank*

School Name

School Address

Street Address Address Line 2 City State ZIP Code

Previous Promotions In Order of Highest Rank

(Rank & Belt/Promotion Date/School/Instructor & Rank)

1.*

2.

3.

Forms Trained In

Kicho
Taegeuk
Palgwe
Kukkiwon Yudanja (Black Belt Poomsae)
Moo Duk Kwan
Pyung Ahn
ITF

Digital Signature and Agreement*

I certify the accuracy of the above information and agree to abide by the rules of the USTA.

Parent/Guardian Approval (for individual under 18)

I approve the applicant's membership in the United States Taekwondo Association if under 18 years of age.

Annual Membership $30/year
Please make check payable to Chosun Taekwondo Academy and send to:

USTA c/o Chosun Taekwondo Academy
60 Galloway Road
P.O. Box 721
Warwick, NY 10990

Individual Membership

INDIVIDUAL MEMBERSHIP FORM

Present Rank Information

Present Rank Instructor Information

Previous Promotions In Order of Highest Rank

After submission, you will be transferred to our shopping cart to purchase your membership.