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World Headquarters
709 Oregon Avenue
Philadelphia, PA 19148
(215) 468-2121

MEMBERSHIP APPLICATION~--~~~~--~
for

OFFICIAL USE ONLY

Membership No _ _ _ _ _ __
Region _ _ _ _ _ _ _ _ __
OGup xj!J Dan Expiration Oate _ _ _ _ _ _ __
Other _ _ _ _ _ _ _ _ _ __
PLEASE PRINT

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ Date of Birth _ _ _ _ _ _ __

Last First Inilial Mo Day Year

Address
No

USA
State Zip

Tel. No. o Male o Female

Email _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Education _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Occllpation _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

For Gup: No _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ WhmGup _____________________

Current Rank
If Any

For Dan: Dan No _ _ _ _ _ _ _ _ _ _ _ _ _ __

WhmOan - - - - - - - - - - - - - - - - - - ­

Name of Oojang (Studio) The Do j ang KMAA, LLC Sam

Rank & Name of Instructor _ Dan
___ _ _Charles
______ Richards
_ _ __

Ome _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Applicant _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(Signature)

Fee Enclos~d $ _ _1--'_"_0_0

_ __________ Guardian _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
(II applicant is under 16)

By signing above, I acknowledge that I am applying for membership in the World Tang Soo Do Association, that I have read the member­
ship agreement on the reverse side of this application, and that I will respect and obey all rules and regulations of the wrSOA and my
member studio.

Studio Recommendation

I recommend the above applicant for membership of the World Tang Soo Do Association

Studio Name _....:T:::.ch:.:....::e:..-.:D=-o=:..J.j..:::a:.:n~g~_.:.K.:.:M.:::.A=A:..!,~L=L~C=___________________

Chief
Signature

The original (white) copy of the application should be sent to: World Tang Soo Do Association, 709 Oregon Avenue, Philadelphia, PA
19148. Make check or money order payable to wrSOA. The yellow copy is for the student (guardian).

If approved, gup membership will automatically terminate when the applicant achieves Black Belt or stops training for a period of more
than one (1) year. Dan members must renew annually.

WH ITE - wrSDA Copy YELLOW - Student Copy