First Name:  Last Name:

Date of Birth:   Current Belt or Rank:

Address Street: Apt #:

City: State: Zip Code:

Telephone (incl. area code):    E-Mail Address:

First Name: Last Name:

Contact Phone or Email:

In Group Test - Saturday June 7th, 2025
at Manna's Martial Arts School
This option no longer available - this test completed

Semi Private Test - Wednesday, June 11th - 5:30 PM
at Manna's Martial Arts School
Register on or before June 10th: $60
Register after June 10th: $80 (incl. late fee)

By clicking on the “submit” button on this form, I submit this application for promotion in Manna’s Martial Arts and accept any grade or belt rank rendered by this system with complete satisfaction, neither contesting nor demanding a higher grade or belt rank.

Participant Parent/Guardian of applicant as named above  Date:

Please fill in ALL required fields indicated with a red star (), above date format mm/dd/yyyy.