UNITED STATES INTERNATIONAL TAEKWON-DO FEDERATION NATIONAL HEADQUARTERS President Master Robert N. Wheatley P.O. Box 33205 Reno, NV 89533 PHONE 775-826-2355 MEMBERSHIP APPLICATION Please print or type application. Name will appear on cards as it appears on this application. Last Name _______________________________ First Name ______________________________ Address __________________________________________________________________________ City ___________________________________State ____________ ZIP CODE_______________ Present Rank _____________ Black Belt Certificate no. _________________________________ (if ITF Certified) Male Female Age _________ Telephone # (_____) ______________ e-mail: _______________________ Date of Birth _____________________________ Your Instructor’s Name __________________________ School ____________________________ Instructor’s Rank ____________________________ Is he / she ITF Certified? Yes Do you practice ITF patterns ? Yes No Annual Membership Fee $25 Please mail this form to: USITF c/o Mr. Gordon Jue 5460 Sunol Blvd. #8 Pleasanton, Ca 94566 Return application and fee to your instructor. Make check payable to your Instructor or representative of the USITF No UNITED STATES INTERNATIONAL TAEKWON-DO FEDERATION NATIONAL HEADQUARTERS President Master Robert N. Wheatley P.O. Box 33205 Reno, NV 89533 PHONE 775-826-2355 SCHOOL MEMBERSHIP APPLICATION NAME _________________________________________INSTRUCTOR’S RANK ___________ HOME ADDRESS _______________________________________________________________ SCHOOL NAME ________________________________________________________________ ADDRESS ______________________________________________________________________ HOME PHONE ________________ SCHOOL PHONE ______________ FAX _____________ INSTRUCTORS NAME & RANK __________________________________________________ INSTRUCTOR’S ITF BLACK BELT CERTIFICATE NUMBER ________________________ Please! Include a brief history of your Taekwon-Do training as well as copies of all certificates and one passport photograph, along with a list of all instructors in your school. After reviewing the above requested information, and if approved, membership numbered USITF plaque will be sent as soon as possible. All Black Belt students from other organizations need to be recommended by an officer of the USITF. FIRST TIME MEMBERS $150.00 ANNUAL MEMBERSHIP FEE: $75.00 Please make checks payable to: United States International Taekwon Do Federation Please mail this form to: USITF c/o Mr. Gordon Jue 5460 Sunol Blvd. #8 Pleasanton, Ca 94566 United States International Taekwon-Do Federation Grade (gup) Test Form Name (The way it will appear on your certificate) Please Print (Adults Fill Out For Minors) Age phone # Address City State Do- Jang Instructor Current Rank Rank Testing For Test Fee ITF No. Zip Test Date Paid by: Cash Check Credit Card Time Since Last Test I hereby request to be tested for promotion and agree that the judges shall be the only persons who are qualified to promote me or fail me on the basis of my technique, knowledge of the art and attitude. I also understand that I must have written permission from the master instructor to attempt to skip rank or to miss the tournament part of the testing when it is required. I also agree that I will not engage in the business of instruction or other activities of the United States International Taekwon-Do Federation without the written permission of this organization. Parent's Signature (if the student is under the age of 18) Student's Signature DO NOT WRITE BELOW THIS LINE (THIS SECTION FOR EXAMINER ONLY) Examiner's Name Test Category Examiner's Recommendation Grade Comment Hand Combinations: Basic Kicks: Multiple Kicks: Flying Kicks: Step Sparring: 1 2 3 Semi Free Basic Intermediate Advance Examiner's Signature Instructor's Signature Testing Category Grade Comment General Manner and Appearance Required Pattern # 1 Required Pattern # 2 Required Pattern # 3 Choice Pattern General Knowledge History, Philosophy Ho Sin Sul Required Break #1 Required Break #2 Required Break #3: Sparring Results of examination Fail Incomplete Pass United States International Taekwon-Do Federation President Master Robert N. Wheatley PO. Box 33205 Reno, NV 89533 PHONE 775-826-2355 Dear Instructor, Welcome to the United States International Taekwon-Do Federation. Enclosed you will find a brief history of the USITF, a guide line on protocols, school and individual membership application. Feel free to make as many copies of the applications for you and your students as you require. As a quick summary of the USITF... The United States International Taekwon-Do Federation is an official governing body for the International Taekwon-Do Federation (ITF). All standards are those set by the ITF and the USITF. Students testing under a certified ITF instructor / testing board are recognized Nationally and Internationally. Some of the events you will find with the USITF / ITF are: • International, National, Regional, State, and Local tournaments throughout the year • International, National, and Regional Summer Camps • Seminars • Business Seminars • International instructor's courses • Referee seminars • Instructor's course • Regional, State and Local seminars Memberships • Individual membership receives the following: • 1 ITF patch • USITF and ITF identification cards • Members are entitled to have free lessons at Taekwon-Do schools throughout the world that are registered with the I.T.F. outside their own town of residence. • School membership • Receives an ITF recognized school certificate • Interested students in your area will be given your school name, address, phone, and contact • Be able to host International, National, and local events • Other benefits for being a school member I look forward to talking and meeting with you in the near future. Please feel free to contact me at (925) 484-0308. Thank you. Yours In Taekwon-Do, Mr. Gordon Jue, VI Dan USITF - Vice President of Business Affairs