Blue Wave Black Belt Testing Winter Camp 2023: Testing Candidate Information

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Please fill out this form ONLY if you intend to test at Blue Wave Winter Camp Black Belt Testing, March 17th, 2023. Please speak with your instructor about paying testing fees.

Your name will appear on your Black Belt Certifications as it is entered here. Email gwhite@bluewavetkd.com with any issues. Photos will be taken at testing.

First Name *

Middle Initial

Blank is OK

Last Name *

Gender *

M or F

Month Date of Birth *

for example "July"

Day - Date of Birth *

"19"

Year Date of Birth *

"1988"

Uniform Size - This does not mean you will receive a uniform, instructors may* request this information *

Belt Size *

Street Mailing Address *

City or Town *

State *

Zip Code *

Current Rank *

Testing for the Rank of *

I have registered with the Kukkiwon TCON Website, this is required for ALL RANKS. If you have not yet registered: CLICK HERE TO REGISTER WITH TCON DECIDED CANDIDATES CLICK NO *

Yes

Kukkiwon Cert Number or TCON ID

DECIDED CANDIDATES TYPE N/A

KKW cert number, OR TCON ID (username)

Current Chung Do Kwan Dan number *

type N/A if testing for 1st Dan or you do nont have one

Blue Wave Dojang Location *

for example - Bradford

Email Adress *

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