Okinawa Karate-Do Muso-Kai gAssociate Membersh Application
(Please copy and fax or mail it. Please print)
I understand and agree with your organizationes purpose and rules and apply to be a member of my own free will.
Signature________________________ Date(Month) _______ (Day) ________ (Year)_________
Name (First)_________________________________(Last)____________________________________
If you want to use a different name on the homepage
_______________________________________________________
Address: Country ______________________ Zip__________________________
State/Province________________________________________________
City/Town _________________________________________________
Street______________________________________________________
Phone#________________________ FAX_______________________
E-mail _______________________________________________________
Birth date (Month)________(Day)________(Year)_________
Occupation/School____________________
Circle the information you want posted on our homepage
Last Name / First Name / Country / State / City / Town / Phone# / Email Address / Age
Annual Fee US$100 _____Pay Pal
_____Check
Please make the check payable to Okinawa Karate-Do Center
Address:
Okinawa Karate-Do Center Phone: USA801-262-1785
153E 4370S #15 Fax: USA801-262-1785
Murray Utah 84107
U. S. A.