USBBF Membership Registration Form

Name *

First NameMiddle NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Date of Birth*

Date

Age

E-mail*

Phone Number:*

Social Media

Gender*

Felony Conviction?*

Date You Began Training?*

Year

Instructors Name

Current Rank*

Martial Art Style/System(s)*

Training History - Systems and Ranks*

Affiliation*

Club or School Name and Full Address - Independent Leave Blank

Member Of Martial Arts Organizations? Please List

The applicant acknowledges and agrees that they are not authorized to use the United States Black Belt Federation authority, name, or logo in any manner without permission from United States Black Belt Federation. The United States Black Belt Federation name and logos may not be used on any letterhead, certificates, logo’s or facsimile’s of logos and on uniforms, created or outsourced by the applicant school(s,) instructor(s), and student(s).
However, the member is allowed to wear the United States Black Belt Federation patch on their uniform. You are of course welcome to say your a member, share USBBF posts, all the things any member would do just dont make yourself out to be something your not. If you want to use the logo in your advertising - let us know and we'll work with you.

Agree?

International Memberships Accepted
International membership packages may be delivered electronically for printing and display or may be mailed. Electronic packages will NOT include a patch or ID card.

If you want physical delivery of your Life Membership package (International Only - Outside the US), please select INTERNATIONAL SHIPPING in addition to anything else.

Contact us at info@usblackbeltfed.com with questions.

Multiple forms, documents, money orders, checks may be submitted via mail. Use "Print Form" button and mail to P.O. Box 666 Gardendale, AL 35071. Documents may be scanned and submitted via email to info@usblackbeltfed.com.

USBBF LIFE Membership $75.00

Never wonder when your membership expires. Membership materials will ship to you. Member certificate, patch, ID card included.

USBBF Annual Membership $25.00

Renew via renewal application. Annual Memberships are for a 12 month period. Membership materials will be delivered electronically.

USBBF Annual Membership Renewal$25.00

Membership materials will be delivered electronically.

USBBF Member Patch$12.00

One patch already included in Life membership.

Quantity
Item subtotal:$0.00

International Shipping$15.00

International Shipping of Life membership materials. Select ONLY if you are outside the US AND want physical delivery of materials.

Quantity

Total $0.00

Payment Methods

Credit Card

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Cash App Pay

Application For Membership

Payment Methods