USBBF Membership Registration Form

Application For Membership
Name *

First Name Middle Name Last Name

Address: *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Date of Birth *

Month Day Year
Date
Age
E-mail *
Phone Number: *

Area Code Phone Number
Social Media
Allow USBBF to repost ?
Gender *
Felony Conviction? *
Instructors Name
Current Rank *
Martial Art Style/System(s) *
Training History - Systems and Ranks *
Affiliation *
Club or School Name and Full Address - Independent Leave Blank
Member Of Martial Arts Organizations? Please List
The applicant acknowledges and agrees that they are not authorized to use the United States Black Belt Federation authority, name, or logo in any manner without permission from United States Black Belt Federation. The United States Black Belt Federation name and logos may not be used on any letterhead, certificates, logo’s or facsimile’s of logos and on uniforms, created or outsourced by the applicant school(s,) instructor(s), and student(s).
However, the member is allowed to wear the United States Black Belt Federation patch on their uniform. You are of course welcome to say your a member, share USBBF posts, all the things any member would do just dont make yourself out to be something your not. If you want to use the logo in your advertising - let us know and we'll work with you.
Agree?
USBBF Annual Membership $ 60.00

USBBF LIFE Membership $ 175.00

USBBF Annual Membership Renewal $ 45.00

USBBF Member Patch $ 10.00

Quantity

Total $ 0.00

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Multiple forms, documents, money orders, checks may be submitted via mail. Use "Print Form" button and mail to P.O. Box 666 Gardendale, AL 35071. Documents may be scanned and submitted via email to info@usblackbeltfed.com.
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Application For Membership