Application for Dan Promotion
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WORLD TANG SOO DO ASSOCIATION General Sparring Point Point APPLICATION FOR DAN PROMOTION Allgemein Peleando (PLEASE PRINT) Essay Il Soo Sik General Attitude Sam Soo Sik Date of Test : Terminology Ja Yu Dae Ryun General Knowledge Da Soo Dae Ryun(Multi) FOR STUDENT Teaching Ability Took Soo Dae Ryun(Special) Assoc. Membership No. or Dan number If any Decision Yes No Decision Yes No Name Sex : Male Female Basic Self‐Defense Point Point Last First Init Basico Auto Defensa Address : Basic Hand Techniques Ho Sin Sool No Street City State Zip Date of Birth : Tel: ( ) - Combination Hand Techniques Rolling MO DAY YR Basic Kick Techniques Back Falling E-MAIL: Occupation: Combination Kick Techniques Self‐Defense with Weapon Hand & Kick Combinations Decision Yes No Present Grade: Date of Last test: Decision Yes No Breaking I hereby submit my application for Dan promotion in the World Tang Soo Do Point Hyung Rompiendo Association. I have read the agreement for promotion test ON THE REVERSE SIDE(or Point NEXT PAGE) of this application or Student’s Test Agreement in Dan Manual P.47 and Forma Hand fully understand and agree to all terms and conditions. Foot Other Method Applicant’s Signature Month of birth if emailed Guardian’s signature (if under 18 years) Month of Birth if emailed Decision Yes No Jumping FOR INSTRUCTOR Point Decision Yes No Saltando I have evaluated the above and hereby recommend him/her for Dan of Weapon Front Kick Point Studio Name Arma Side Kick Instructor Bong Hyung Il Bu Round House Kick Bong Hyung E Bu Other Advanced Kicks Required for Dan Applications Yes No 1. Valid Dan membership card or 4. Essay Bong Hyung Sam Bu Decision Valid Gup membership card if you are Cho Dan Bo 5. Testing Fee Bong Sool Hyung Sah Dan – 4th 2. Dan Test Application 6. Three (3) Passport photos Dan Kum Hyungs 1‐2 Pyung Ahn Sah Dan Ro Hai 3. Dan Registration form and first 3-year membership fee* 7. Building Fund Donation Jang Kum Hyungs 1‐2 Kong Sang Koon Jang Gum Hyung Joong Koop Jang Gum Hyung *3 year membership fee for Cho Dan & above is required if Dan membership expires at the end the year. Any additional Weapon Any Junior Hyung requested by the Testing Decision Yes No Panel FOR EXAMINER: th Cho Dan – 1st Oh Dan – 5 Point System A. Excellent (90‐100) B. Good (80‐89) C. Average(70‐79) Pyung Ahn Hyungs Bassai Pyung Ahn Oh Dan Wang Shu Naihanchi Cho Dan Sip Soo Shi Shan All Jang Gum Hyungs D. Recommended (60‐69) E. Fail (59 & under) Bong Hyung Il Bu and E Boo Ji Pang Yi Hyung Any Junior Hyung requested by the Testing Decided Any Junior Hyung requested by the Testing Panel Panel Recommended nd th We recommend promotion of this student to Dan E Dan – 2 Yuk Dan – 6 Pyung Ahn E Dan Naihanchi E Dan Bassai Jion Hyung Examiner(s) 1. Bong Hyung Sam Bu Ro Hai All Jang Gum Hyungs Any Junior Hyung requested by the Testing Any Weapon Hyung (Advanced and Special) 2. Panel Any Junior Hyung requested by the Testing rd Panel Sam Dan – 3 3. th Pyung Ahn Sam Dan Jin Do Chil Dan – 7 Chairman of Test Committee: Naihanchi Sam Dan Dan Gum Hyung Pyung Ahn Cho Dan Oh Sip Sa Bo Ki Cho Jang Gum Hyung Sae Jang Kwon Hyung All Jang Gum Hyungs Chairman of Technical Advisory Committee: Any Junior Hyung requested by the Testing Any Weapon Hyung (Advanced and Special) Panel Any Junior Hyung requested by the Testing President of World Tang Soo Do association: Panel Please attach an additional page for remarks if there’s any. Agreement for Black Belt Examination I, the signed applicant on the reverse side, hereby agree to abide by and observe all the rules and regulations of the World Tang Soo Do Association and will accept any grade or belt rendered by this Association with complete satisfaction, neither contesting nor demanding a higher grade or belt. The Association hereby agrees to furnish a competent judge and adequate facilities for the promotion examination and will also issue an identification card and certification in accordance with the requirements listed in the current Black Belt Manual. I understand and agree that the promotion examination fee is not refundable under any circumstances. I recognize the strenuous nature of this activity and I agree to hold the WTSDA, its officers, instructors, testing examiners, guests and members, my affiliated studio and the location where this promotion examination is being conducted harmless of any liability or damages for personal injuries I may sustain during said promotion examination. I further agree that any pictures taken of or by me in connection with said examination may be used by the WTSDA for publicity or promotion purposes without compensation at this time or any other time. If I successfully complete the requirements for Black Belt rank, I hereby agree that I will not violate any of the following conditions of membership as outlined in the current Black Belt Manual. If at any time I violate any of the conditions therein or if I violate any of the following conditions expressly agreed upon between the WTSDA, my studio and me, I will agree that the WTSDA and my studio reserve the right to withdraw and revoke any rank and/or status. I agree to pay any and all liquidated damages to the WTSDA as a result of violating the above conditions and/or rules and regulations of the WTSDA. Said liquidated damages shall be fair and reasonable. 1. I will strictly adhere to the attendance requirements of the WTSDA and my member studio and will participate in the number of classes, seminars, clinics and other activities determined by the WTSDA and my studio as part of the requirements for my rank and grade to enhance my mental, physical and spiritual health. 2. I pledge to protect the honor and dignity of the Art of Tang Soo Do through my behavior inside and outside of the dojang. 3. I am prohibited from using or executing any Tang Soo Do techniques or other martial arts techniques unless it reasonably appears necessary to defend myself or another against an apparent threat of unlawful and immediate violence from another. 4. I will not engage in the demonstration or instruction of the Art of Tang Soo Do in any form whatsoever or under any circumstances without the express written permission of the WTSDA and/or my studio. 5. I agree it is the total discretion of the WTSDA to suspend or expel any member from his or her membership or from the WTSDA for conduct unbecoming a member of the WTSDA. Conduct unbecoming is determined as any conduct which is not in keeping with the standards of the WTSDA. Any member who is suspended or expelled from the WTSDA may not train or participate in events at any member studio. Any studio owner, after notice of said member’s suspension or expulsion, who allows that member to train at their studio or participate in studio events will risk the loss of their studio membership in the WTSDA. 6. I understand that the WTSDA must strictly regulate the location of new member studios, clubs, schools, and facilities in order to protect the privileges and rights duly accorded to every existing member studio. Therefore, I hereby agree that the WTSDA has the exclusive right to decide and regulate the location of new member studios and/or clubs which are opened or established within fifteen (15) miles from the location of any existing sanctioned WTSDA studio or club. I acknowledge that a violation of this provision may cause extensive damage to the Association and its member studios and I expressly agree not to violate same. 7. If I ever become inactive for a period of more than three (3) months or if I ever become lackadaisical in my training after my promotion to Black Belt, my rank may be re-evaluated and I may be demoted to a lower rank. 8. I agree that if I ever cease to be a member of the Association, whether voluntarily or involuntarily, I will not hold myself out as a current member of the WTSDA. I further agree to refrain from displaying or showing any certificate or identification card which contains the WTSDA trademark and/or WTSDA logo, both of which are protected by US Trademark Registration No. 1,327,588. I have read and fully understand this agreement and agree that all the terms and conditions shall be deemed to exist and bind all of the parties herein signed on the front side of this agreement. .