Copies of current certificates are necessary to process orders for any form of rank recognition. If copies are unavailable, a videotape of appropriate skills is required. Other materials will be shipped prior to receipt of verification materials.

Name:_____________________________________ Address:_____________________________
City: ________________________ State: _________ Zip: ________ Email: ________________

$____ Traditional Lifetime Membership - Hand-drawn Traditional Rank Certificate $80.00 includes - member card, membership certificate, Traditional (large 14"x17" rice paper) rank certificate, patch (Japanese, Korean or Chinese - circle one)
Art/Rank:_____________________________________
Japanese/Chinese/Korean calligraphy (circle one)
$____ Addl Traditional Certificates ___ x $40
Art/Rank:_____________________________________

$____ Deluxe Lifetime Membership - Hand-drawn Rice Paper Rank Certificate $70.00 includes - member card, membership certificate, Deluxe (11"x14" rice paper) rank certificate, patch Art/Rank:____________________________________
Japanese/Chinese/Korean calligraphy (circle one)
$____ Addl Deluxe Certificates ___ x $30 Art/Rank:____________________________________
Japanese/Chinese/Korean calligraphy (circle one)

$____ Traditional Lifetime Membership - Hand-drawn Traditional Rank Certificate $85.00 includes - member card, membership certificate, Traditional (large 14"x17" parchment paper) rank certificate, patch (Japanese, Korean or Chinese - circle one)
Art/Rank:_____________________________________
Japanese/Chinese/Korean calligraphy (circle one)
$____ Addl Traditional Certificates ___ x $45
Art/Rank:_____________________________________

$____ Deluxe Lifetime Membership - Hand-drawn Rank Certificate $75.00 includes - member card, membership certificate, Deluxe (11"x14" parchment paper) rank certificate, patch Art/Rank:____________________________________
Japanese/Chinese/Korean calligraphy (circle one)
$____ Addl Deluxe Certificates ___ x $35 Art/Rank:____________________________________
Japanese/Chinese/Korean calligraphy (circle one)

$____ Premier Lifetime Membership $45.00 includes - member card, membership certificate, rank certificate, patch
Art/Rank:_____________________________________
$____ Addl Premier Certificates ___ x $10 Art/Rank:_____________________________________

$____ School Charter $25.00 (one-time) School/Art:________________________________
$____ Instructor Certificate $15.00 (one-time) Art:_______________________
$____ Headmaster/Founder Certificate $175.00 Art:______________________

$_____ Addl Federation Patches ____ x $5.00 each


$_____Total Fees
Cash, Cashier's Check or Money Order Payable to Robert Shook (all checks held two weeks)

I pledge on my honor that the information provided in this application and its attachments are true and accurate representations.

_______________________________________
Signature / Date

Mail to: Robert Shook, 4725 Slippery Rock, Fort Worth, TX 76123