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29th National Collegiate Taekwondo Association Championships(1)

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					                    36th National Collegiate Taekwondo Championships
                                       April 9-10, 2011

NATIONAL COLLEGIATE SCHOOL/CLUB INSTITUTIONAL MEMBERSHIP
APPLICATION FORM

In order for a collegiate Taekwondo club to have voting rights, and for a club to be counted in
the standings of the NCTA championships, the club must pay the $100 membership fee, and also
be certified as a group recognized by the university or college that they represent.

Payment can be made by mailing the following before March 23, 2011:

      1) A check or money order to “National Collegiate Taekwondo Association”
      2) A letter of recognition by the institution that you are representing (see next page)
      3) A completed copy of this form

To:
      2011 Collegiate National Taekwondo Championships
      c/o UC Davis Taekwondo
      P.O. Box 72538
      424 3rd Street
      Davis, CA 95617

Please do not use signature verification or return service when sending in your eligibility forms
as it may significantly delay your paperwork!

Alternatively, registration and payment may be done in person at registration during the 2011
NCTA Championships in Davis, CA


School Name: __________________________________________________________________

Club Name: ___________________________________________________________________

Club Contact Person:____________________________________________________________

Club Contact Email:____________________________________________________________

Club Contact Phone:____________________________________________________________

Club Web Site: ________________________________________________________________

Club Address: ________________________________________________________________

Club City/State/Zip:____________________________________________________________


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                  36th National Collegiate Taekwondo Championships
                                     April 9-10, 2011

                              Letter of Institutional Recognition

Club Name: ___________________________________________________________________

Club Representative Name: _______________________________________________________

Club Representative Title: _______________________________________________________

Club Representative Signature: ______________________________________ Date: _________

Club Representative email: ______________________________________________________

Club Representative phone: _____________________________________________________

I certify that the above named club is recognized as an organization in good standing with this
school:

School Name: __________________________________________________________________

School Representative Name: _____________________________________________________

School Representative Title: ______________________________________________________

School Representative Signature:_____________________________________ Date: _________

School Representative email: ______________________________________________________

School Representative phone: _____________________________________________________




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