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Membership Form


DYNAMIC FIGHTING ARTS

Individual Membership Application
Individual Membership (lifetime): $ 50.00

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You receive a Free T-Shirt, Certificate showing that you belong to our organization, free video of your choice, membership card and access to free classes when you are in our area.
If you want your picture added to the certificate make sure to send a picture with your name in an email to us.

Your Name
Address
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Your Email Address
Age
Occupation
Art/Style
Rank
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If you prefer to mail it to us please print and fill out the following Membership Application
mail  to: Dynamic FightingArts
    P.O Box 531183
              Cincinnati, Ohio 45253
 

Make Check or Money Order to David Seiwert

Name:___________________________________________________________

Address:_________________________________________________________

City: ________________________________ State: ______  Zip: ____________

Age: _________

Occupation:______________________________________________________

Email address:____________________________________________________

Art/Style: __________________________________ Rank: ____________________

City: ___________________________ State: ________

Other Training:____________________________________________________

Memberships/Affiliations:___________________________________________

Please accept my application for individual membership in the Dynamic Fighting Arts Organization. I have enclosed my membership dues.

Applicant Signature___________________________________Date_________________


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