| American Soceity of Combat Martials Artists |
Name: ___________________________________________________________________________ Street Address: ___________________________________________________________________ City: ______________________ State: ____________________ Zip Code ____________________ Date of Birth:_______________ Sex: _______________ Email Address:______________________ Current Instructos Name: ___________________________________________________________ Current Rank: _________________________ Date Achieved_______________________________ Belt Color: ________Style/Art_______________ School or Dojo ________________________ School or Dojo Address _____________________________________________________________ _________________________________________________________________________________ |
| Membership Application |
| Send Completed Application and Copies of all Certificates to: ASCMA 102 West Skyview Road Austin Tx. 78752 |
| Liability Wavier Statement I Certify that I have been made aware of potential hazard involved in martial arts and training for self defense. I am physically fit and have no medical condition which would preclude me from participation in these activities. I acknowledge the potential hazards involved and by signing this application wave for myself, heirs,executors, or anyone else who might have claim in my behalf the right to sue. releasing American Society of Combat Martial Artist, its instructors, facilities in which actives are conducted, and anyone acting on their behalf, from any and all liability claims for personal injury, physical or emotional, or death stemming out or in the course of participation in these activities. This extends to all claims whatsoever the nature or kind where it is known or unknown or foreseen or unforeseen. __________________________________________ ________________________ Signature Date __________________________________________________________________________ Parental Consent if under 18 _____________________________________________________________________________ Print Name /Parent's Name Home |
| Rank Registration (All Rank Registation is $20 each) 10 -6 Kyu Ranks $__ 5 - 1 Kyu Ranks $__ 1st -5th Dan $__ 6th - 8 th Dan $__ 9th - 10th Dan $__ Total $ _________ |
| Instructor Registration (All Instructor Regration is $75 each) (Note rank registration is different from Instructor Registation) 1st Dan -3rd Dan $____ 3rd Dan -5th Dan $____ 6th Dan -8th Dan $____ 9th Dan $____ 10th Dan $____ $ _________ |
| (If an item does not apply enter N/A) |
| For application renewal Click Here |