AKTS Individual Membership Registration Form

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Please review the liability and release waiver agreement https://goo.gl/YrmgXT and enter registrant information below. One submission per applicant can be made at a time. After submitting registration, you will have an option to submit payment online or by mail.

INDIVIDUAL/STUDENT REGISTRATION or MEMBERSHIP RENEWAL
Please include $20.00 for a 1 year membership.

For MEMBERSHIP RENEWAL, include existing AKTS Membership card number.

Please note that all PayPal payments include a nominal additional transaction fee.

Make checks payable to:

ADVANCED KENPO TRAINING SYSTEM

c/o Louis T Donadio
195 SE Crystal Lake Drive

Corvallis, OR 97333

PAYPAL LINK FOR MEMBERSHIP or RENEWAL:

Individual Membership or Renewal ($21.00) PayPal Link: https://goo.gl/xmFvoR.

FAMILY DISCOUNTS AVAILABLE
Please contact your instructor.

SCHOOL REGISTRATION
School and Club Membership is available. Please use this link for details and to apply for or renew AKTS School Membership: https://forms.gle/3htG67M28jcaHCYE8

Allow up to 4 weeks for application processing. Applications will be reviewed by the Board of Directors. Applicant(s) shall be notified by mail as to the status of acceptance.

Payments sent via mail must be received within two weeks from date of registration. Upon receipt of payment and pending review of application, your instructor will provide you with a valid AKTS membership card.

Email *

Name *

Phone Number *

Mailing Address *

Please choose:

This is a new Individual Membership

This is a renewal of an existing Individual membership

Clear selection

AKTS Membership Number (if renewing):

Date of Birth *

YYYY

Gender: *

Female

Male

Occupation and Employer

Martial Arts School Name *

Name of Instructor *

AKTS Belt Rank *

Are you Presently a Member of a Martial Arts Organization? *

Yes

Required

Were you Formerly a Member of a Martial Arts Organization? *

Yes

Required

Description of Martial Arts Training History *

I have Read and Agree to the Release Waiver Liability Agreement.

Please review: https://goo.gl/YrmgXT

Yes

Required

I confirm that the above information is correct to the best of my knowledge and do hereby submit this application for membership with the ADVANCED KENPO TRAINING SYSTEM by entering my full name below, which serves as a digital signature: *

Payment Method *

I intend to pay online via PayPal (A transaction fee will be added to all PayPal transactions)

I intend to send payment via mail

Required

Send me a copy of my responses.

Submit

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