The International Chinese Boxing Association Preserving the Legacy of Chinese Martial Arts

Grago's Southern Shaolin Chinese Boxing - Ch'uang Chuan Pai
Preserving the Legacy of Chinese Martial Arts!

Copyright © 1978 - 2008 ICBA World Wide. All Rights Reserved.

www.wwicba.com
Individual Membership Registration Form
For Accuracy, Please Print or Type Neatly!

Members receive: ICBA Members Card, Patch and Full Association Rights and Privileges
SEND A COPY OF YOUR CURRENT RANK CERTIFICATE AND RECEIVE A FREE ICBA CERTIFICATE OF RANK ACCEPTANCE

The ICBA is a fraternal Chinese Martial Arts Organization you must be enrolled in a
martial arts program or enrolled in the ICBA Independent study program to become a member.

IF YOU ARE A SHI-FU / SCHOOL OWNER PLEASE EMAIL US FOR THE SCHOOL MEMBERSHIP PACKAGE

Previous ICBA Membership Number if any_________________________________________
Regional Sports Organization or Affiliation (if any)____________________________________
Name_____________________________________________________________________
Sex M( ) F( )
Date of Birth Month Day Year 20___
Citizenship ____________________________
Address___________________________________________________________________
City____________________________ State________ Zip________________
Phone____________________________
Fax (if any)____________________________
Email (required)____________________________
Website___________________________________
Date Training Began__________________________
Rank____________________________
Style____________________________
Club____________________________
Sifu____________________________

Signatures:

Requester________________________________________________________________
Parent/Guardian if under Legal Age___________________________________________

Registration Date____________________
Amount of $25.00 per year membership fee due and please pay by money order. NO PERSONAL CHECKS ACCEPTED

Print form and send to ICBA HQ with US$25 Money Order

ICBA HQ
1800 USA Drive
Plano, TX 75025

Questions? Email chairman@wwicba.com