BLACK DRAGON ASSOCIATION
Membership Application
Print This Document And
Mail To:
Black Dragon Association Attn:
Frances Romney
3373 S. 2040 W.
West Valley City, UT
84119 USA
_______________________________________________________________________________
- NAME:___________________________________________________________________
- ADDRESS:________________________________________________________________
- CITY:_____________________________________________________________________
- ZIP/POSTAL CODE:__________PHONE:(_____)____________COUNTRY:__________
- MARTIAL ARTS STYLE:_______________________________________________
- RANK:_________________________ DEGREE:_____________________________
- NUMBER OF STUDENTS (if you teach):___________________________________
- E-MAIL:______________________________________________________________
- WEB URL:____________________________________________________________
- COMMENTS:_______________________________________________________________
- ____________________________________________________________________________
- ____________________________________________________________________________
- ____________________________________________________________________________
____________________________________________________________________________
Please complete this application and send to the address
shown above.
Please assist me in keeping this a dues-free organization
by enclosing a self-addressed, stamped 8 X 11 envelope for mailing your membership
certificate (suitable for framing), or enough international postage coupons
to mail you an 8 X 11 envelope.
___________________________________________________________
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