TAGB Membership Application Please complete this form in full. If the applicant is under 18, the parent/guardian section will appear automatically. Application type New application Renewal Re-starting Lost details School TAGB school Instructor Master Geoff Gravestock International Instructor and 6th Degree Black Belt TAGB James Flaxman Instructor and 5th Degree Black Belt TAGB Paul Beames Assistant Instructor and 2nd Degree Black Belt TAGB Previous TKD school (if any) Previous ID number Licence number Licence expiry date Grade number Dan or Kup Kup Dan Senior or Junior Senior Junior (under 16) Gender Male Female Medical Tick any that apply: Heart disorder Asthma Migraine Epilepsy Diabetes Nervous disorder Haemophilia Hay fever Any others Physical injuries or disabilities Have you ever been convicted of a crime of violence? No Yes If yes, details Training history Date commenced training Date of last grading Your details Forenames Surname Address line 1 Address line 2 City / town Postcode Phone number Email Occupation Date of birth Parent / guardian (required if under 18) Parent/guardian name Relationship Parent phone Parent email Membership type Individual (once weekly) – £35.00 Individual (twice weekly) – £45.00 2 family members – £65.00 3 family members – £90.00 4 family members – £120.00 Training location Keresely Village Community Centre Meon Vale Leisure Centre Stratford upon Avon Community Sports Centre Consent & acknowledgements I consent to photos being taken at events I confirm I will set up the standing order payment I acknowledge I must hold a current TAGB licence I have been shown my insurance details I do NOT wish to receive information from the TAGB Declaration I understand that there is an inherent risk of physical injury in the practice and learning of a contact sport such as Tae Kwon-Do. In signing below I accept the TAGB's full disclaimer of liability and agree to abide by the rules of the TAGB. I accept the declaration Signature Sign below using your finger or mouse. If the applicant is under 18, the parent/guardian should sign. Clear signature Date Submit application
