Saskatchewan WT Taekwondo Association Membership Subscription

Please enter information on the form below to process subscription for Saskatchewan WT Taekwondo Association Membership.

Club Name

Zone *

First Name *

Last Name *

Address *

City *

Postal Code *

Phone *

Phone 2

Email *

Sex *

Male

Female

Age on 2021/01/01 *

Keup

Date of Birth *

DAN Certificate #

DAN Certificate Level

Aboriginal volunteer self declaration. ***this data will be used for NAIG funding and will remain confidential ***

Please initialize for self declaration

Taekwondo Canada Membership # __SK-

Taekwondo Canada National Licence Registrant (GAL) (GOL) _CAN-

Respect In Sport # (RiS)

https://www.sasksport.ca/programs-education/respect-in-sport/
SEE : http://www.saskwtf.ca/pdf/2017-18_Poster_Awards.pdf

Coaching Level (RiS - required)

IC= Instructor CLASS

IT = Instructor Taekwondo Blackbelt

NCCP# (National Coaching Certification)

https://coach.ca/
**must have NCCP and RiS to be considered a coach for funding

Sport Specific :

Assistant Instructor - AI trained (year)

Dojang Coach - DC trained (year)

Program Coach - PC trained (year)

NCCP Assistant Instructor Certified year

NCCP Dojang Coach Certified year

NCCP Performance Coach Certified year

National Instruction Coach -sport-specific skills and training Evaluator (year)

OTHER : please specify

Referee Level:
RiS - required

Referee Level Achieved

(year if known)

Last Refresher Taken (year)

Where

IR International Referee Level #

Signature:
I agree that by submitting this application, I am electronically signing this application.

I,

Full Name *

solemnly declare that the information I have provided is true.

Date *

Membership #

Payment Information

Price

Payment Method

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Saskatchewan WT Taekwondo Association Membership Subscription

Payment Information

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