JRMA Membership Mail In Application

Make Checks or Money orders payable to: Primetime / Kidsafe

                                                Mail to : P.O. Box 304 Mission, Texas  78573

Parent / Guardian _____________________________________________

Full Name of Applicant _________________________________________

Address_____________________________________________________

City_______________________  State_______________  Zip__________

Home Phone:(_____)_____________  Cell Phone:(______)_____________

e-mail Address:_______________________________________________

Martial Art School _____________________________________________

Address_____________________________________________________

Phone (____)_________________________________________________

Facility Name or School Where Applicant Attends Class:

___________________________________________________________ 

Type of Membership Desired:

___ Lifetime Membership

___ Affiliate Organization

___ Charter Group

Rank Recognition:

Current Rank:_________________Style /Art Form:___________________

Current Rank:_________________Style /Art Form:___________________

Current Rank:_________________Style /Art Form:___________________

Current Rank:_________________Style /Art Form:___________________

Current Rank:_________________Style /Art Form:___________________

* Use back of form or additional paper if more space is necessary.

Promotions:

Current Rank, Sash or Belt Color:_____________________

Date of Last Rank Exam:___________________________

Rank Desired:___________________________________

Sash or Belt Color Desired:_________________________

* Use back of form or additional paper if more space is necessary.

Martial Arts Training History:

*Use back of form or additional paper if more space is necessary.

JRMA Membership Page