HEAD INSTRUCTOR APPLICATION (PLEASE PRINT OR TYPE) NAME (LAST) _______________________________________________ FIRST _________________________ INITIAL _____ ADDRESS _________________________________________________________________CITY _________________________ STATE ______________________ ZIP CODE ____________________________ COUNTRY ___________________________ DATE OF BIRTH ________/________/_________                                      PHONE # (________) __________________________ EMAIL _____________________________________________________ ADDITIONAL PHONE # (_________) _____________________________ PRESENT RANK _____________________          DATE OF RANK _________/_________/_________ CERTIFICATE # _______________________ ISSUED BY ________________________________________________________ I, THE UNDERSIGNED DO HEREBY APPLY FOR HEAD INSTRUCTOR STATUS WITH NORTHERN KNIGHTS MARTIAL ARTS AND AGREE TO OBSERVE ALL THE POLICIES AND PROCEEDURES AS SET FORTH BY THE NKMA BOARD OF DIRECTORS. IN CONSIDERATION THEREOF, I HEREBY AGREE THAT SHOULD I FAIL TO ABIDE BY NKMA POLICIES I MAY BE DISMISSED AND I SHALL NOT BE ENTITLED TO A REFUND OFF ANY KIND. I AGREE THAT AT SUCH TIME I AM NO LONGER AFFILIATED WITH NORTHERN KNIGHTS MARTIAL ARTS ANY INFORMATION, POLICIES, PROCEDURES OR REQUIREMENTS DIRECTLY RELATED TO THE NKMA ORGANIZATION SHALL NOT BE COPIED IN ANY MANNER. ______________________________________________________________     ________________________________________                                    APPLICANT’S SIGNATURE                                                                                 DATE APPROVED BY _________________________________________________              _________________________________________________                            NKMA – PRESIDENT                                                                          NKMA-VICE PRESIDENT