Trainer

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

Your Name: ___________________________________________________________
Your Physical Address: ___________________________________________________
Your Gym/Club Name: ___________________________________________________
Your Gym/Club Mailing Address if Different of Above. _____________________________________________________________________________
Your Gym/Club Phone Number: ________________________________________________
What RULE STYLE do You Teach: ___Full Contact ___ Intl ___ MuayThai ___ San Shou
Do you teach COMPETITIVE Kickboxers? _____YES _____NO
Your Training Background In Kickboxing. (Use back if necessary)
- _______________________________________________________
- _______________________________________________________
- _______________________________________________________
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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