Membership Application

Name: __________________________________________  Gender:  Male q          Female q

Date of Birth: _____/_____/__________ Age: ___ Height: _______ Weight: _____

Address: _____________________________________________________________________

City: _______________________________     State: _____________     Zip Code: ___________

Telephone: (_____)_______________________     Business: (_____)______________________

Email: _________________________________     Web site: ____________________________

Please provide a martial arts biography: ________________________________________

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Comments: ____________________________________________________________________

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Membership Fee: Life Time Membership $50.US

Optional: Your bio. and photos on our Website.         Yes q    No q

I attest that the above information is correct and by signing below

I accept my induction into the UNITED FELLOWSHIP of MARTIAL ARTISTS Membership.

Signature ____________________________________________     Date _____/_____/__________