AKTS Membership Registration Form
Please review the liability and release waiver agreement
and enter registrant information below. One submission per applicant can be made at a time. After submitting registration, you will have an option to submit payment online or by mail.
Make checks payable to: ADVANCED KENPO TRAINING SYSTEM
5826 N Sutherlin St.
Spokane, WA 99205
Please include $20.00 for a 1 year membership. For MEMBERSHIP RENEWAL, include existing AKTS Membership card number and submit payment at the following link:
. Please note that Paypal includes a nominal additional digital delivery fee.
FAMILY DISCOUNTS AVAILABLE
Please contact your instructor.
Please include $100.00 for a 1 year school membership (20 or more students) or $50.00 for a 1 year membership (19 or fewer students). First year of membership may be prorated depending on date of signup. Please include 2 (two) passport photos and a copy of your last rank certificate if you have had any formal Martial Arts training.
For SCHOOL RENEWAL:
Paypal payment link for schools with more than 20 students:
Payment link for schools with less than 20 students:
Please note that Paypal includes a nominal additional digital delivery fee.
Allow up to 4 weeks for application processing. Applications will be reviewed by the Board of Directors. Applicant(s) shall be notified by mail as to the status of acceptance.
Payments sent via mail must be received within two weeks from date of registration. Upon receipt of payment and pending review of application, your instructor will provide you with a valid AKTS membership card.
This is a new membership
This is an existing membership renewal
AKTS Membership Number (if renewing):
Name of Instructor
Agustin Oyarzun - Chile
Allen Saunders - USA
Bob White - USA
Chauncy Emerine - USA
Chris Tanaka - USA
Daniel Hernandez - USA
David Coppock - USA
Denis & Maria Ciccarelli - USA
Denise Plowman - USA
Derek Reichman - USA
Francisco Espinoza Guajardo - Chile
Greg Moench - USA
Joe Peterson - USA
John Sepulveda - USA
Juan A. Martial - USA
Juan Pablo Morales - Mexico
Kurt Becker - USA
Louis Donadio - USA
Matt Greenland - USA
Mylisa Chrisp - USA
Randy Blake - USA
Rob Deluca / Ralph Porzio - USA
Rob Hazlewood - USA
Sandra Dee - USA
Sean Crehan - USA
Sergio Gonzalez R. - Chile
Shane Thomas - USA
Sigung Stephen LaBounty - USA
Steve Cordaro - USA
Tim Murphy - USA
AKTS Belt Rank
3rd Degree Brown
2nd Degree Brown
1st Degree Brown
1st Degree Black
2nd Degree Black
3rd Degree Black
4th Degree Black
5th Degree Black
6th Degree Black
7th Degree Black
8th Degree Black
9th Degree Black
Date of Birth
Occupation and Employer
Are you Presently a Member of a Martial Arts Organization?
Were you Formerly a Member of a Martial Arts Organization?
Description of Martial Arts Training History
I have Read and Agree to the Release Waiver Liability Agreement
I confirm that the above information is correct to the best of my knowledge and do hereby submit this application for membership with the ADVANCED KENPO TRAINING SYSTEM by entering my full name below, which serves as a digital signature:
I intend to pay online via Paypal
I intend to send payment via mail
Send me a copy of my responses.
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