Membership

Please click below for the membership file in pdf form, or print the page and fill out the form below.

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2010 KRANE MEMBERSHIP APPLICATION (Deadline July 31, 2010 to retain
all points since January!)

$59.00 Membership Fee

Send to: Krane Ratings
93 Cogliandro Dr.
Acton, ME 04001

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Name__________________________________DOB_______

Address____________________Apt#______

City__________________Country_____________State______Zip_______

Home Phone_______________Work Phone______________

Fax/e-Mail_________________

Affiliation/School____________________

Address____________________Suite#_____

City________________State_____________Zip____________

Phone Number___________________Instructor_______________

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Please circle the appropriate information below.

I am currently a KRANE member: COMPETITOR REFEREE

Current Krane Competitor number_______________

I am a Black Belt: YES NO Degree_______

Style_______________

My current Belt Rank is_______________________

Circle one: BEGINNER INTERMEDIATE ADVANCED BLACK BELT

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