ISA ASSOCIATION APPLICATION

If you have an Association/Federation/Alliance that you would like recognized world-wide, then fill out this form.

* LAST NAME:

* FIRST NAME:

* MAILING ADDRESS:

* CITY:

* STATE:

* ZIP:

* COUNTRY:

* TELEPHONE:

* ISA ID #:

* ASSOCIA. NAME:

* AGE:

* DATE OF BIRTH (DD/MM/YYYY):

* YOUR RANK:

* IN WHAT STYLE?:

* YEAR STARTED IN MARTIAL ARTS?:

YOU MUST BE AN ISA MEMBER AND HAVE YOUR RANK CERTIFIED WITH
THE ISA, BEFORE APPLYING FOR AFFILIATE CERTIFICATION! THIS
APPLICATION MUST HAVE YOUR ISA MEMBER ID NUMBER ON IT! Print this
application and fill out. Send a FEE of $150.00 for your AFFILIATE
certificate.
Make Business/Personal Checks or Money Orders payable to:
GEORGE I. PETROTTA
MAIL TO:
GEORGE PETROTTA
137 Timberlake Dr.
Florence, SC 29501 USA

* Indicates Response Required