Respecting the past, Creating the future!
AIKIA Application
________________________________________________________________________________________________________
(Name)
(Date of Birth) (e-mail address/web site)
________________________________________________________________________________________________________
(Street address)(Apartment
or P. O. Box number)
________________________________________________________________________________________________________
(City)
(State) (Zip code)
(Phone number)
In _________ (year)
I received the 1st degree black belt from my instructor ___________________________________
(name of instructor) whose school was/is located at _______________________________________________________________________
(address of school).
Include a copy
of all black belt certificates. Any misinformation may result in
forfeiture of your application fee.
Fee:
$199 includes the Black Belt member certificate, Black Belt Instructor
certificate and Black Belt Agent certificate. You also receive the
Agent business manual with complete instructions on Dan testing,
completing Agent forms and running your martial arts school. As
agent you may purchase the student memberships (card and patch)
for only $7 each (retail value $20). You are authorized to issue
the AIKIA
kyu/gup certificates
($4 each/retail $20). You are also authorized to issue Aikia Dan
certificates ($30 per Dan).
The yearly renewal
fee is only $99 or you may request an AIKIA Lifetime Agent membership
for only $995 (includes the initial $199 fee).
Optional: As
our agent you may license the WKI/WHI/WTI/WFMMA/WKenpo logos for
only $99 per year.
Use the logos to
promote your school in all forms of advertising (not to include
any documents of rank or membership) including T-Shirts, gis, advertisements,
posters, flags, etc. The AIKIA certificates of rank include each
logo.
Please
find my fee of _____________ enclosed (please use money order).
Dr. Jerry Beasley
P. O. Box 402
Christiansburg
VA 24068
