North American Martial Arts Federation APPLICATION Date _________________ First Name _________ Last Name ____________________________ Address ___________________________________________ City__________________________State ___ Zip Code ____________ Male __________ Female ____________ DOB ___/___/______ Current Rank _____________ Phone Number: ________________ E-Mail Address: ________________________ This application is for one of the following: Gup Membership: $25 one time fee. Dan Membership: first year $45. Renewable I am paying my Black Belt (Dan) Annual fee of $45 Due by January 15, of each year. Black Belt Testing fee $160.00 + ($45 Annual Dan Fee) This application may be faxed to the following number: 561-482-1896 Credit Card Number: __________________________________________ Exp. Date ______________ Total $_____________ Make Checks payable to North American Tang Soo Do Federation 11435A Palmetto Park Rd. Boca Raton, FL 33428 For Information call 561-482-9049 Parents Signature (if under 18 years of age) _________________________________