Kodanja/Black Belt Event Registration Form

WTSDA Region 4 Event Registration Form

Fill out the form carefully for registration
Registration Inquiries:
Int'l Master Patrick West
Email: MasterWest@TexasTangSooDo.com
Participant Name

First NameLast Name
Birth Date

MonthDayYear
Gender
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Studio
Rank
If new CDB, provide promotion effective date:

MonthDayYear
Date
Are you a current member of the Region 4 Moo Do Society?
If you are not a Region 4 Moo Do Society Member, please register at Online Moo Do Society Membership Form.
Event
Event Fee
What is your role?
Earned Points
Additional Comments
I, the undersigned, assume all risks for injury that I may sustain in connection with this seminar and waive claims against instructors, any other students, participating studios, the Regional Director, the World Tang Soo Do Association (WTSDA) and its officials, or hosting facility. I will strictly observe and obey all rules and regulations governing this seminar.
Accept Waiver
Payment

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Debit or Credit Card

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WTSDA Region 4 Event Registration Form