International Sungja
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INTERNATIONAL SUNGJA-DO ASSOCIATION International Headquarters PO BOX 6004, FLORENCE, SC 29502 USA Telephone: 1-843-393-7111 ISA I.D. #: _____________ Date of Birth_______________ INSTRUCTORS APPLICATION Name: (Last) __________________________ (First) _______________________ (MI) ___________ Address: ___________________________________ City: ___________________ State: _____ Country: ____________ Zip Code: ____________ Telephone #: (_____)_______________________ Age: _________ Martial Arts History: Date Started: _______________ Style: _________________________________ Your Present Rank and Style: _______________________________________ Date Received: ___________ Instructor's Name and Rank: ___________________________________________________________ Organization Issuing Rank: __________________________________________________________________ Name of School Attending: [ ] Own [ ] Teach[ ] Student (Check Appropriate Box/Boxes) INSTRUCTOR CERTIFICATION: (will receive Instructor Certificate) [ ] Assistant Instructor: (6 th Grade to 1 st Degree ) [ ] Instructor: (2 nd Degree to 4 th Degree ) [ ] Master Instructor: (5 th Degree to 9 th Degree ) (Only Check One) _______________________________________________________________________________________ _______ I hereby make application for the above name Individual as a qualified Instructor in the InternationalSungja-Do Association, .he or she has taken a written and physical exam to certify them as an instructor! I accept all conditions of responsibility for the above named individual, and we sincerely pledge to obey all rules and regulations which are set up for the purpose of keeping order of the association and for the protection of students from injury! _______________________________________________________________________________________ _______ Date_________ Instructor’s Signature_________________________________
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Transcript of International Sungja
INTERNATIONAL SUNGJA-DO ASSOCIATIONInternational HeadquartersPO BOX 6004, FLORENCE, SC 29502 USATelephone: 1-843-393-7111ISA I.D. #: _____________ Date of Birth_______________
INSTRUCTORS APPLICATION
Name: (Last) __________________________ (First) _______________________ (MI) ___________
Address: ___________________________________ City: ___________________ State: _____ Country: ____________
Zip Code: ____________ Telephone #: (_____)_______________________ Age: _________
Martial Arts History: Date Started: _______________ Style: _________________________________
Your Present Rank and Style: _______________________________________ Date Received: ___________
Instructor's Name and Rank: ___________________________________________________________
Organization Issuing Rank: __________________________________________________________________
Name of School Attending: [ ] Own [ ] Teach[ ] Student(Check Appropriate Box/Boxes)
INSTRUCTOR CERTIFICATION: (will receive Instructor Certificate)[ ] Assistant Instructor: (6th Grade to 1st Degree )[ ] Instructor: (2nd Degree to 4th Degree )[ ] Master Instructor: (5th Degree to 9th Degree )(Only Check One)______________________________________________________________________________________________ I hereby make application for the above name Individual as a qualified Instructor in the InternationalSungja-Do Association, .he or she has taken a written and physical exam to certify them as an instructor! I accept all conditions of responsibility for the above named individual, and we sincerely pledge to obey all rules and regulations which are set up for the purpose of keeping order of the association and for the protection of students from injury!______________________________________________________________________________________________
Date_________ Instructor’s Signature_________________________________
___________________________________ ___________Applicant’s Signature Today’s Date
Print this application and fill out. Send a FEE of $5.00 for your Assistant Instructor certificate, a FEE of $10.00 for your Instructor certificate and a FEE of $15.00 for Master Instructor certificate.Make Business/Personal Checks or Money Orders payable to: GEORGE I. PETROTTAMAIL TO:GEORGE PETROTTAPO BOX 6004FLORENCE, SC 29502-6004
