Lion’s Den Martial Arts

Charter Membership
Application
No.____ $100.00 / Lifetime

Name____________________________ DOB ___________ Sex ___________

Address__________________________ Phone # _________ - _________________

___________________________ Email Address _______________________

City _____________________________ Website Address______________________

State ____Zip Code ______ Country______ School Owner? Yes_______ No________

School Name ________________________ How Many Branches? _________________

School Address _______________________ School Phone # _______- ______________

________________________ How Many Students? __________________

City ________________ Martial Arts Experience______________________________

State ____ Zip Code_______ Country________ ______________________________

Instructor’s Name ________________________ Martial Arts Style _________________

*Please send application with copy of current rank certificate (if any) along with check or
money
order to: ( Make checks or money orders payable to Lion’s Den )
Lion’s Den Martial Arts
413 N.Durham Ave.
Creedmoor,NC 27522