IKF
TRAINERS
LICENSE - REGISTRATION
FORM

Please print out this form, fill it out & mail or fax, along with your License/Registration Fee of $25 for 1 Full Year (Year starts when we receive this form) to
IKF P.O. Box 1205, Newcastle, CA, 95658, USA or FAX to 916.663.4510

PLEASE "PRINT" NEATLY

  1. Your Name: ___________________________________________________________
  2. Your Physical Address: ___________________________________________________
  3. Your Gym/Club Name: ___________________________________________________
  4. Your Gym/Club Mailing Address if Different of Above. _____________________________________________________________________________
  5. Your Gym/Club Phone Number: ________________________________________________
  6. What RULE STYLE do You Teach: ___Full Contact ___ Intl ___ MuayThai ___ San Shou
  7. Do you teach COMPETITIVE Kickboxers? _____YES _____NO
  8. Your Training Background In Kickboxing. (Use back if necessary)
  9. Your PAST EXPERIENCE (Competition if any) In Kickboxing. (Use back if necessary)

Please send this Form and your TRAINERS LICENSE - REGISTRATION Fee of $25 to: IKF Attn: TRAINERS LICENSE - REGISTRATION
P.O. Box 1205, 9250 Cyprus Street, Newcastle, CA, 95658, USA - (916) 663-2467 - FAX: (916) 663-4510
Registration Forms WITHOUT FEES will be Disposed of.

IF PAYING BY CREDIT CARD ($30) AND FAXING IN (916) 663-4510 - PRINT NEATLY!
CIRCLE OR CHECK ONE: _____VISA -OR- _____MASTERCARD


CC#: ___________ ___________ ___________

PHONE: (________) __________ _____________


$30.00


CARD EXP. DATE_______/_______/_______

3 DIG SEC CD: _____ - _____ - _____

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