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PKC Membership Registration Form
PKC #
Last name
PKC Member Since
First name
Regional Director's Name
City State Zip
Email
Cell Phone #
Current Rank
Style/System
Your Instrucor's Name
Your Instructor's Rank
Your Instructor's Cell #
Name of Martial Arts School
Adress of Your Martial Arts School
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Individual Membership (New) - $40.
Individual (Renewal) - $25.
Lifetime Membership - $200.
Associate School Membership (New) - $125.
Associate School (Renewal) - $100.
Additional Amount Due to PKC - $25.
Additional Amount Due to PKC - $50.
Additional Amount Due to PKC - $100.
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