Welcome to the Shaolin Chuan Fa Martial Arts Association
By filling out this application you are on your way to opening the door to growth, knowledge, and friendship.
This application is the first step to acceptance into the CFMA (Shaolin Chuan Fa Martial Arts Association). To ensure the continued high training standards of the CFMA each applicant is required to submit verification of program and lineage. This submitted information simply verifies formal training and DOES NOT prevent the “break away” program from joining the association. The following requested information must be verifiable, and further requested material may be required before final evaluation of you, or your program. Final evaluation of an applicant program is outlined below and in further detailed in the Chuan Fa Association & Guidelines Booklet.
1. Application process and verification of applicant. 2. Applicant receives a letter of congratulations; with request of presentation of their self, or through video/DVD, for Board evaluation of training methods. 3. Acceptance into the association is by vote of the Board. 4. Upon majority acceptance by the Board, the applicant will then receive an acceptance letter; requiring finalization of application costs, and commitment.
There is a required, NON-refundable, application fee of $30.00. This should be paid by check or money order, made out to the processor listed on the back of this application.
Please provide the following information in full. If a line does not apply, insert “N/A”
Applicant Name: (First, M.I., Last) ___________________________________________________________________
(Please print)
Street address: _____________________________________________ City: ________________________State: _____
Zip Code: ____________ Phone # (home) ( ) ______________________ Phone # (cell/school) ( ) ____________________
Best time to contact applicant: Day______________ time: _____________ AM / PM
Please check the appropriate space: I am applying for myself: _______ or for a school: ______?
If application is for a school, please submit the following: School Name: ____________________________________
Number of locations:_________ Name of senior teacher/master: ____________________________ Rank: _______________
Date of first Black Belt: ________ please include a separate list of all of your instructors, their ranks, and date of last rank.
Primary style of instruction: ie Kenpo, Hapkido, etc: _________________________________________________
Secondary style: ___________________________________ previous styles taught: __________________________________
Number of black belts in your program:__________ non-ranked students: _________ Students under 13 years of age: ________
Email: _________________________________________ web page/URL: _________________________________________
Applicant MUST submit the following regardless if application is for school or individual use:
Name of Instructor who promoted you to black belt: _______________________________________
School name of promoting instructor: __________________________________________________________________
Address: ______________________________________
Enclosed: Check___ or Money Order ___ made payable to Dr. Dennis Fitch in the amount of $30.00 for application fee Applicants please submit with this application: COPIES of any, and all, certificates of black belt rank with appropriate instructor
signatures. A brochure copy of your school (if applicable). A full list of ranked students (as requested in application). The above provided information is factual and submitted honestly and in good faith. The applicant understands the application process
and is aware that all materials obtained will not be returned; furthermore, that all materials obtained are for the confidential use of the CFMA ONLY.
City:_______________State: _____ Zip: ____________
Phone # (business/cell) _____________________ Email: _____________________
Mail to: Dr.Dennis N. Fitch
1263 Sanibel Lane
Gulf Breeze, FL 32563
Signature: ___________________________________________ Date: _____________
Any applicant applying to join CFMA understands that liability, injury, and medical insurance must be maintained by the applicant. CFMA does NOT provide insurance coverage for any applicant. Furthermore, CFMA can not be held legally, or civilly, responsible for any injury sustained by any member, or student of member, during any event held, hosted, affiliated, or associated with CFMA
