2008 PSKL MEMBERSHIP APPLICATION
Click below for the PDF version of this form:
Membership Form
$35.00 Membership Fee
Send completed application and payment to:
  PSKL Ratings
  33 Bernhard Rd.
  North Haven, CT 06473
Name   DOB  
Address  
   
City   State   Zip Code  
Home Phone   Work Phone  
Email  
Affiliation/School  
Address  
   
City   State   Zip Code  
Phone Number  
Instructor  
 
Please circle the appropriate information below:
Current PSKL Competitor number  
I am a Black Belt YES NO  
Degree  
Style  
Current Belt Rank  
Circle one BEGINNER

INTERMEDIATE

ADVANCED

BLACK BELT