* = Required Field

*First Name

*Surname

*Phone

(numbers only please)

*Email

*Sex

Choose one... Female Male

*Rank

Choose one... White (10th Gup) Yellow I (9th Gup) Yellow II (8th Gup) Yellow III (7th Gup) Blue I (6th Gup) Blue II (5th Gup) Blue III (4th Gup) Red I (3rd Gup) Red II (2nd Gup) Red III (1st Gup) Cho Dan Bo 1st Dan 2nd Dan 3rd Dan 4th Dan 5th Dan 6th Dan 7th Dan 8th Dan 9th Dan

*Date of Birth:

Date:

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Month:

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Year:

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Weight (Sparring)(kg):

(enter up to one decimal place eg 46.1)

Membership No:

Medical Conditions/Allergies:

*Emergency Contact details:

*Paying By:

PayPal

*Instructor and Club

Choose...NOT LISTED ABDUL KHALEEL -- Club:JAYANTH REDDY INTERNATIONAL TAEKWONDO ACADEMY -- Email:infojitacademy@gmail.com -- Phone:8121676057 Adam Morris -- Club:Kicks Martial Arts -- Email:adam@kickstaekwondo.com.au -- Phone:0421342222 Aja Wyman -- Club:One Taekwondo -- Email:admin@onetkd.com -- Phone:0411611162 Alan Harlick -- Club:Edge Taekwondo Gold Coast -- Email:ajharlick@hotmail.com -- Phone:0421566447 Alex Sootho -- Club:Musa Taekwondo -- Email:alex@musataekwondo.com -- Phone:0410719405 Alf Dellorso -- Club:Melbourne Taekwondo Centre Malvern -- Email:malvern@taekwondo.com.au -- Phone:0411837041 Ali Khalil -- Club:Global Martial Arts -- Email:ali@globalmartialarts.com.au -- Phone:0405600403 Allan Malachowski -- Club:Martial Fitness Australia -- Email:info@martialfitnessaust.com -- Phone:0433895537 Amy Tierney -- Club:Tierneys Taekwondo Academy -- Email:tierneystaekwondoacademy@gmail.com -- Phone:0427248839 Andrew Rozinszky -- Club:Melbourne Taekwondo Centre Glen Waverley -- Email:mtcglenwaverley@gmail.com -- Phone:0395616122 Andrew Treadwell -- Club:Phoenix Martial Arts Aust -- Email:coach@phoenixtkd.com.au -- Phone:0402429318 Anita Tippet -- Club:Taekwondo Oh Do Kwan -- Email:pktkd@bigpond.net.au -- Phone:61417961226 Arash Mozhdeh -- Club:Mozhdeh Martial Arts -- Email:Info@mozhdehmartialarts.club -- Phone:0468932989 Ashlee Ward -- Club:Edge Taekwondo Charter Towers -- Email:Edgetkdct@gmail.com -- Phone:0424779409 Barry Altanhan -- Club:Fastkix Martial Arts -- Email:fastkixtaekwondo@outlook.com -- Phone:0435760013 Ben Hartmann -- Club:Hartmann Taekwondo -- Email:ben@hartmanntkd.com.au -- Phone:0410702357 Benjamin Flinn -- Club:Flinn Taekwondo Academy -- Email:instructor@flinntkd.com -- Phone:0409167422 Cameron Taylor -- Club:San Taekwondo -- Email:cameron@santkd.com -- Phone:0437571540 Camille Pruckmuller -- Club:Koryo NZ -- Email:c_kelly@xtra.co.nz -- Phone:0274297557 Carlo Massimino -- Club:Team Carlo Taekwondo -- Email:carlo@teamcarlo.com.au -- Phone:0390779901 Carlos Lakerdis -- Club:Lakerdis Martial Arts -- Email:head.instructor@caboolturetkd.com.au -- Phone: 0414090609 Carly Reasbeck -- Club:Spirit Taekwondo Newcastle -- Email:Carly.reasbeck@gmail.com -- Phone:0422133911 Cheri Parks -- Club:Swordsmen Martial Arts -- Email:swordcheri@gmail.com -- Phone:0412440528 Claudia Murray -- Club:Taephoon Martial Arts Academy -- Email:taephoonmaa@gmail.com -- Phone:0407123800 Craig Drabsch -- Club:Reeves Taekwondo -- Email:craigtkd@bigpond.com -- Phone:0414230942 Darran Mcnulty -- Club:Dragon Taekwondo -- Email:info@dragontaekwondo.com.au -- Phone:0408962040 Darryl Green -- Club:Edge Brisbane -- Email:Green@edgetkd.com.au -- Phone:0414752413 David King -- Club:KMA Brisbane -- Email:davidkingtkd@gmail.com -- Phone:0410645552 David Levestam -- Club:Cardinals Taekwondo -- Email:dlevestam@gmail.com -- Phone:021427333 Di Carn -- Club:Irontiger Taekwondo -- Email:dicarn@irontiger.com.au -- Phone:1300788550 Elias Moufarrej -- Club:Royal Empire Martial Arts -- Email:elias.m@royalempirema.com.au -- Phone:0423685942 Frank De Pasquale -- Club:City West Taekwondo -- Email:sdepasquale@optusnet.com.au -- Phone:0402900222 George Nissirios -- Club:St George Martial Arts -- Email:george.nissirios@sgmaa.com.au -- Phone:0419253800 Harry Saltis -- Club:Melbourne Taekwondo Centre Bayside -- Email:mtcbayside@gmail.com -- Phone:0424895397 Igor Geyl -- Club:5th Element Martial Arts -- Email:igorgeyl@gmail.com -- Phone:0411534582 Jaidyn Snowden -- Club:Dragon Martial Arts -- Email:jaidynrsnowden@gmail.com -- Phone:0403480347 Janaki Tamang -- Club:Dynamic Taekwondo Dojang -- Email:amintamang31@gmail.com -- Phone:9779861125693 Jason Smith -- Club:Spirit Taekwondo Brookvale -- Email:Info@spirittaekwondo.com.au -- Phone:0299386466 Jeff Crane -- Club:Haktari Taekwondo -- Email:haktari@bigpond.net.au -- Phone:0418663144 Jimmy Pain -- Club:Tactics Taekwondo -- Email:tacticstkd@gmail.com -- Phone:0408373878 Jin Keun Oh -- Club:Sejong -- Email:sejongtkd@gmail.com -- Phone:0275368861 John Masiello -- Club:Forza -- Email:Info@forzatkd.com.au -- Phone:0410407761 John Tsoutis -- Club:Red Dragon Taekwondo -- Email:jtsoutis@gmail.com -- Phone:+61419165416 Joshua Warren -- Club:Hoju Martial Arts -- Email:manager@hojuma.com -- Phone:0438774351 Junior Maetia -- Club:Taekwondo Solomon Islands -- Email:junior7memp@gmail.com -- Phone:6777503505 Kajal Shrestha -- Club:Nepal Team -- Email:kazzushrestha@gmail.com -- Phone:9841333057 Kane Watene -- Club:Capital City Taekwondo -- Email:Amk_tiling@yahoo.co.nz -- Phone:0223155951 Kangho Park -- Club:PK Taekwondo -- Email:pktkdaus@gmail.com -- Phone:0432359848 Karim Dighou -- Club:Olympic Martial Arts Centre -- Email:admin@olympicmartialarts.com.au -- Phone:0427337718 Kate Eggar -- Club:Yun Hap Taekwondo -- Email:president@yunhaptkd.com.au -- Phone:0408982248 Kiara Evans -- Club:Halls Taekwondo -- Email:info@hallstaekwondo.com -- Phone:0393300032 Kijoo Kim -- Club:HK Taekwondo -- Email:kimkijoo04@gmail.com -- Phone:0452385085 Kiwan kim -- Club:Kiwan mixed martial arts -- Email:kimkiwanhapkido@gmail.com -- Phone:0422837221 Kumar Lawot -- Club:Team Nepal -- Email:gunda8070@gmail.com -- Phone:977983622877 Kumar Manandhar -- Club:Jorpati Taekwondo Dojang, NEPAL -- Email:manandhar123@hotmail.com -- Phone:9779841680062 Kutae Kim -- Club:Kyu Taekwondo -- Email:admin@kyutaekwondo.com.au -- Phone:0481829403 Maddy Houston -- Club:Factor 10 -- Email:maddy@factor10.com.au -- Phone:0433901411 Master Arshad -- Club:SWIFTKICKS TAEKWONDO CLUB -- Email:mmataekwondoclub@gmail.com -- Phone:6591798752 Matt Vale -- Club:Southern Stars Taekwondo -- Email:sstkd@outlook.com -- Phone:0410816836 Michael Tan -- Club:Tans Taekwondo -- Email:Mt@Tans.Com.au -- Phone:0404052609 Mitchell Archer -- Club:Asp Taekwondo -- Email:mitchell.archer@hotmail.com -- Phone:0475673326 Nadia Van Vliet -- Club:Kennedys Fma -- Email:kennedysfma@gmail.com -- Phone:64277590431 Natalia Sangalang -- Club:Taya Taekwondo -- Email:tayatkd@bigpond.com -- Phone:0411449210 Nicole Hyun -- Club:Revolution Taekwondo -- Email:rev.hero1986@gmail.com -- Phone:0435280040 Nicole Vickery -- Club:Sunbae Korean Martial Arts -- Email:support@Sunbae.net -- Phone:0432808191 Noo Ri Chung -- Club:Woori Taekwondo -- Email:Wooris.tkd@gmail.com -- Phone:0433221740 Paula Sitapa -- Club:Tonga Taekwondo -- Email:taekwonpaul@yahoo.com -- Phone:0414607082 Peter Vass -- Club:Prodigy Martial Arts -- Email:petervassily747@hotmail.com -- Phone:0404940265 Rami Fraij -- Club:Rami's Thunder Martial Arts Academy -- Email:thunder_info@yahoo.com -- Phone:0433556517 Relma Bule-Turner -- Club:Hedland Taekwondo Club -- Email:rbuleturner3@gmail.com -- Phone:0408903733 Richard Lister -- Club:New Plymouth TKD -- Email:nptaekwondo@mail.tidyhq.com -- Phone:64211590493 Russell Macarthur -- Club:Russell Macarthur TKD -- Email:info@macarthurtaekwondo.com -- Phone:0413873397 Ruth Hock -- Club:Adelaide Taekwondo Academy -- Email:ruth@adelaidetkd.com.au -- Phone:0401025576 Ryan Carnelli -- Club:Notorious Martial Arts -- Email:info@notoriousma.com.au -- Phone:0430085002 Sadhbh Sweeney -- Club:Global Martial Arts -- Email:sadhbhnic@yahoo.com -- Phone:0424680230 Satyapal Singh -- Club:Negi Taekwondo -- Email:negitaekwondoindia@gmail.com -- Phone:9872333957 Shane Whiteway -- Club:Whiteways Taekwondo -- Email:shanetkd@adam.com.au -- Phone:0403799055 Shirly Sieh -- Club:Sunbae Korean Martial Arts -- Email:Shirly@sunbae.net -- Phone:0434169394 Steve Manning -- Club:Reeves Taekwondo Wellington Point -- Email:kst29176@bigpond.net.au -- Phone:0438124146 Sukwony Choi (daniel) -- Club:JMT Taekwondo -- Email:dan.choi@live.com.au -- Phone:0426877080 Sunil Shakya -- Club:Samari Taekwondo Dojang -- Email:anilrajshakya6@gmail.com -- Phone:9779851227929 Terrence Fernandez -- Club:Martial Arts Spirit -- Email:admin@maspirit.com.au -- Phone:1300627853 Tony Curtis/Jenny Duckworth -- Club:ATI Martial Arts -- Email:malaga@atimartialarts.com.au -- Phone:0892487811 Tung Nguyen -- Club:South Region Taekwondo and Aus Combat Martial Arts -- Email:nguyentkd@outlook.com -- Phone:0412571592 Virender Rawat -- Club:Sports Academy India -- Email:sportsacademyindiasai@gmail.com -- Phone:09416137035 Yosafe Zakoulouta -- Club:Undisputed Martial Arts -- Email:admin@undisputedmartialarts.com.au -- Phone:0490817808 Zak jovanov -- Club:Premier martial arts -- Email:info@premieracademy.com.au -- Phone:94086305 Zhixiang Chen -- Club:Hero City -- Email:herocitytkd@hotmail.com -- Phone:0401580567