UNITED FELLOWSHIP OF MARTIAL ARTISTS 5 Scott St. Riverside New Jersey 08075 USA Tel: (856) 824-0085 website: www.ufo-ma.com      E-mail: hsilee102@yahoo.com

  HALL OF FAME ACCEPTANCE FORM

Name of Recipient: _______________________________________________(Please Print Clearly)

Name of School: ________________________________________________________

_______________________________________________________________

Birthdate:_________________                Age:____________       Rank ____________________

e-mail:_________________________________     website:_______________________________

I attest that the above information is correct and by signing below I accept my induction into

the UNITED FELLOWSHIP of MARTIAL ARTISTS Hall of Fame.

_________________________________                  _____________

Name of Inductee                                           Date

* Please provide a martial arts biography/resume & 1 (photo)

                Official 2011 UFOMA Hall of Fame