MEMBER APPLICATION
PRINT THIS FORM OUT AND FILL IT IN COMPLETELY WITH ALL REQUESTED SIGNATURES AND THE MEMBERSHIP FEE OF $100.00 U.S. OR IT WILL BE RETURNED DENIED. PLEASE MAKE CHECKS PAYABLE TO WCKFC.

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I HEREBY MAKE APPLICATION FOR MEMBERSHIP IN THIS ORGINIZATION,
IN SUPPORT OF THIS, I MAKE THE FOLLOWING STATEMENTS:

 

PERSONAL
INFORMATION

 

 NAME (Please Print)
ADDRESS
CITY/STATE/ZIP
HOME PHONE
IF UNDER 18 PARENTS NAME

OFFICIAL
INFORMATION
FILLED OUT BY AN INSTRUCTOR IF YOU HAVE ONE

 BRANCH
HEADQUARTERS
STUDENT'S DIRECT SUPERVISOR

PERSONAL
STATISTICS

 MALE FEMALE WEIGHT HEIGHT EYES HAIR AGE T-SHIRT SIZE

Are you already a Wing Chun Instructor
YES   NO
If you are an Instructor please define your lineage

STUDENT SIGNATURE
IF UNDER 18 PARENT OR GUARDIAN SIGNATURE

STUDENTS DIRECT SUPERVISOR (IF THERE IS ONE)

MAIL TO: THE WING CHUN KUNG FU COUNCIL.
545 E. TABERNACLE -- ST. GEORGE, UT -- 84770
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