Membership

DYNAMIC FIGHTING ARTS
Individual Membership Application
Individual Membership (lifetime): $ 30.00
Individual Membership (1 year): $ 10.00

1 yr (10.00)

Lifetime (30.00)

You receive a Certificate showing that you belong to our organization, free video of your choice (lifetime only), 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.

Please fill out the following Membership Application, print and
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: ____________________
(Attach copy of Rank Certificate)

City: _______________ State: ________

Name of Instructor: _________________________ His Rank:______________

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_________________