School Application or Renewal (Web)

SEISHIN RYU MARTIAL ARTS ASSOCIATION

*Print out and send to address below - E-Mail:  soshu@seishinryu.com   for fees

P.O. Box 514 Cedar Falls, Iowa 50613 (319) 266-5923

SCHOOL REGISTRATION

SCHOOL NAME :

ADDRESS:                                                                     CITY:

STATE:                                              ZIP:                                  PHONE: (     )     

SCHOOL INSTRUCTOR:                                                     S.R.M.A.A. MEMBERSHIP NO.

YOUR RANK:                                                      TIME IN RANK:

STYLE (Martial Arts Taught at this School):

NAMES & RANKS OF OTHER INSTRUCTORS:

OTHER SCHOOL LOCATIONS (No. students at ea.):

APPLICANTS

Chief Instructor must be a member of S.R.M.A.A. in order that the School qualifies as a member School- refer to Individual Membership Application Form. ** Filled in by SRMAA

S.R.M.A.A. SCHOOL NUMBER:**                 S.R.M.A.A. INDIV. NO.:              DATE :     /     /  

SENSEI:Sign                                DATE:    /     /   REFERRED BY:                            DATE:     /     /  

SRMAA School reg form001

*Print out and send to address above - E-Mail:  soshu@seishinryu.com   for fees