Regional Testing Registration
Twin Cities Regional Tournament
April 23, 2010
Registration Deadline: April 16, 2010
Payments will be taken the day of testing at the test location
Questions? Please contact Mr. Rebnord
at region114testing@hotmail.com or phone 605-360-9553
Last Name:
First Name:
Middle Initial:
Age:
Birthdate:
January
February
March
April
May
June
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August
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October
November
December
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Current Rank:
ATA #:
(Mandatory)
Senior Instructor:
Phone:
-
-
E-mail:
I am:
Testing for Rank
Mid-Term Testing
If Mid-Terming
This is my:
1st
2nd
3rd
Protech Form:
SSJB
SBME
DSJB
DBME
Other
Student
Obtain the approval of your Senior Instructor and complete this registration. Initial below that you have received his/her permission. Application must be made by
February 15, 2010
. PLEASE CHECK IN FOR TESTING AT LEAST 45 MINUTES BEFORE START TIME!
Student's Initials:
I have received permission from my Instructor
Senior Instructor
Please initial and submit this registration by
February 15, 2010
. By initialing below you are claiming that this student has met all of the testing requirements and has your permission to test at the Regional Black Belt Testing.
Instructor's Initials:
I give permission for this student to test
Comments:
Forms like this generate a great deal of spam e-mail. In an effort to reduce that spam, please answer the following question: What is 3 + 6?
The answer is
