HAKKORYU MARTIAL ARTS FEDERATION REGISTRATION FORM
HMAF Fees
Annual dojo membership fee $30
Annual renewal fee per student $30

Name
Street
City State Zip

Phone
Email


If renewal, current HMAF number:

Date of Birth
Place of Birth
US Citizen? yes no
Occupation

Dojo Name
Dojo Address
Dojo City State Zip
Instructor

Current HMAF Rank

List of All Other Ranks:
(rank date style instructor)

Please print this form and mail your check in the amount due made out to "Hakkoryu Martial Arts Federation" to:
Dennis Palumbo, Shihan
c/o Suigetsu Dojo
80B Broadway
Greenlawn NY 11740