Application for a Club to become a member of ANTAA Date of joining (today’s date) Club name: Senior Instructor name: Website: Club email Club dojang locations: Instructor’ names AND ranks: (Should you have a very large list please upload/copy your list here (ensure you include your Club Name and the heading Instructors at the top of your list)) Black Belts names and ranks: (other than those already listed as instructors): Should you have a very large list please upload/copy your list here (ensure you include your Club Name and the heading BLACK BELTS at the top of your list) Total colour belt students (number only): 2 + 13 = Submit