SHIM MYUNG DO

INDIVIDUAL MEMBERSHIP APPLICATION FORM

You may become a member of the Shim Myung Do Federation by filling out the application below and returning it with a check for $35.00 to:

Rod's International Martial Arts
10365 Hammocks Blvd.
Miami, FL 33196

Black Belts please submit a photo and copy of your black belt certificate.

Name: Phone:
Address:
School/Club:   School Phone:
Birthdate: Sex: Male Female      U.S. Citizen: Yes   No

___________________________          _______________________________
Signature of Applicant                                    Signature of Parent or Guardian if a Minor
                 
PLEASE PRINT THIS FORM AND MAIL IT WITH YOUR CHECK AND PHOTO, IT CANNOT BE SUBMITTED ELECTRONICALLY.

Please enclose a check for $35.00 for a one year membership made payable to Rod's International Martial Arts.