ITA Renewals
On-Line Payment Form

International TaeKwon-Do Association
P.O. Box 281
Grand Blanc,   MI   48480   USA

Complete the form below and then click "Submit Application" at the bottom of this page.

Head Instructor Must Collect And Submit Fees For Students

  Now-to-Submit List of Renewing Members 

Please allow 4 to 6 weeks for processing.
(Payments are to be in U.S. Currency)

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Head Instructor's Name:
Head Instructor's ID Number:
Name of School:
School Registration Number:



Address You Want All Documents Sent To

(All renewal cards will be sent to the following address)

Name:
Street Address:
City:
State:
Zip Code:
Country:
Phone: (Required
E-Mail Address (Required)





Credit Card Holder Information

Name (As it appears on Card):
Street Address:
City:
State:
Zip Code:
Country:
Phone: (Required
E-Mail Address (Required)


Credit Card Information

Card Number:      CVV:
    Credit Card:     Exp. Date: Month       Year:



Total Renewal Fees

School Renewal Fee:   x $35.00   =  
Head Intructor Renewal Fee:   x $35.00   =  
Number of Gup Members Renewing:   x $11.00   =  
Number of Black Belts Renewing:   x $12.00   =  
Total Renewal Fees:
 
    

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