Club Membership Registration Form

CBBA Membership Registration Form

Complete the form below to sign up to be a CBBA member.
Name *

First Name Last Name
E-mail *
Phone Number: *

Area Code Phone Number
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Birth Date:

Month Day Year
Martial Arts Background
How long have you been training in the martial arts?

>5 years 5-10 years 10-15 years 15-20 years 20+ years
Are you currently training

Yes No
Are you currently teaching

Yes No
If so, please give the name of your school blanks . Please please give the style that you practice/teach blank.
Are you affiliated with any other organizations or Kais? If so, please provide the names of these organizationsblank.
Christian Background
Are you a born again Christian?

Yes No
Have you read and do you understand the CBBA statement of faith?

Yes No
CBBA statement of faith

https://www.christianblackbeltassoc.org/uploads/5/6/1/7/56173285/cbba_statement_of_faith_revised_april_2016.pdf
Are you a member of a church?

Yes No
If so, please provide your the name of your church and pastorblank.
Do you have any experience/training in Ministry?blank.
Interests:

Japanese Division Chinese Division Korean Division Koinonia Martial Arts conference Martial Arts Chaplains program
Additional
If you would like to give a brief testimony of your Christian experience please do so here:blank.
Once you submit your membership application, we will contact you shortly. Thank you!

My Products

Initial Membership Fee For first time registrants

$ 30.00

Annual Membership Renewal Membership out of date? No problem, re-register here

$ 15.00

Lifetime Membership If you wish to stay with us for a lifetime

$ 300.00

Total

$ 0.00

Now create your own Jotform - It's free! Create your own Jotform

CBBA Membership Registration Form