Membership Checkout 2

Membership Information

You have selected the Promotion Certificate membership level.

White belt through brown belt

The price for membership is $20.00 now.

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Member First Name

Member Last Name

Member Date of Birth

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Member Phone Number

Member Instructor Name

Member Instructor Email Address

Member School Name

Member Rank

Date Rank was Acquired

Member Martial Art Style

Year Member Started Their Art

Your First Name

Your Last Name

Your Date of Birth

Your Age

Your Gender

Your Phone Number

Your Instructor Name

Your Instructor Email

Your School Name

Your Rank

Date Your Rank Was Aquired

Your Martial Art Style

Year You Started Your Art

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Address 1

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