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School/Club Certification
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School/Club Certification
SCHOOL/CLUB CERTIFICATION
If you would prefer, download and fill out the application
HERE
Name of School/Club/College
*
Applicant Name
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First
Last
Phone
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Email
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Address
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Street Address
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About your organization
Number of Students
Number of Black Belts
Number of Instructors
Forms Taught
Kicho
Taegeuk
Palgwe
Kukkiwon Yudanja (Black Belt Poomsae)
Moo Duk Kwan
Pyung Ahn
ITF
Briefly Describe Martial Arts History and Activity of School/Club/College
Briefly Describe Any Affiliation with Any Other Organization
Digital Signature and Agreement
*
I certify the accuracy of the above information and agree to abide by the rules of the USTA.
USTA Rank
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Choose One
1st Dan
2nd Dan
3rd Dan
4th Dan
5th Dan
6th Dan
7th Dan
8th Dan
9th Dan
USTA Certification #
*
Annual Membership $150
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
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