Referee Seminar and Written Test

Black Belt Promotion Test | Referee Seminar & Written Test Registration

Referee Seminar and Written Test Information

Date: Saturday, July 23, 2022
Time: 2:30 PM - 4:30 PM (Including written exam)
Registration Deadline: June 30, 2022 (Complete Regstration form including payment if applicable)
Registration Fee: Included in the black belt test ($50 plus GST if re-test)

Test Applicant Information

First Name *

First

Last Name *

Last

Membership Number

Date of Birth

Age

Address *

Address

Street Address

Apt./Building/Suite #

City

State/Province

Zip/Postal

Country

Email Address *

Phone

Black Belt Referee Written Test

First Written Test

Re-take Written Test

Written Test Re-test Fees

Emergency Contact Information

Emergency Contact Name

First

Last

Relationship to Member Relationship to Member

Emergency Contact Phone Number

Waiver Information

I hereby give permission for myself/my child to participate in Jeon Eui Taekwondo Black Belt Promotion Test - Referee Seminar and Written Test. I understand that there is no refund on referee seminar and written test fee. For extenuating circumstances, the referee seminar and written test may be postponed by providing written notice within 48 hours after the test. Only one postponement will be allowed and it must be re-scheduled within one year. Having read and understood all the information on this form, I hereby allow myself/my child to attend Black Belt Promotion Test - Referee Seminar and Written Test. The Waiver Forms that I have signed at Jeon Eui Taekwondo will also apply to the Black Belt Promotion Test - Referee Seminar and Written Test.

Signature

Clear

Sign by parent or legal guardian if under 19 years of age

Date

Payment Total

Black Belt Promotion Test - Referee Seminar and Written Test

Subtotal

GST (5%)

Total