White Tiger Kenpo Jujits

"The Peace of the Open Palm, Balanced by a Well Formed Fist."

Shihan Jim Rathbone copyrighted© 1993

White Tiger Kenpo Jujits School Membership

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WTKJ School Membership Application

Owner's Information

Last Name:

First Name: Date of Birth:
Address: Apt #:
City: State: Zip: Country:
Home Phone: Work Phone:
Current Rank: Last Promoted:

Former Experience (if any):

School Information

School Name:

Student Population: 
School Address:
New Application:                          Renewal:
Club Membership

Studio membership

Application Fee:
Payment Method:
Credit Card #:                                  Expiration:
Cardholder Signature:

When finished, print form out and mail with payment to:
WTKJ
PO BOX 805
Odessa Fl 33556
Fax: 727-372-3354

 

Shihan Jim Rathbone
6852 Westend Ave
New Port Richey FL 34655
727-372-2404 Phone #
Email: Shihan Jim Rathbone

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