AYMTA Membership Application

Fill out form, print, sign, and mail, with check payable to AYMTA, to:

AYMTA
PO Box 173
Grand Haven, MI 49417
USA
Rewnewal (skip * sections) New Membership

Name
Home Phone
Office Phone
Address
email
Fax
City
State
Zip
Country
* Occupation
Date of Birth
Gender
Male Female
*Referred by

*Your Instructor's Name
School Name
*School Address
School Phone
*City
State
Zip
Country
*What taijiquan or other gongfu have you studied?
Are you an instructor of Yangjia Michuan Taijiquan as taught by Wang Yen-nien? Yes No
If you would like to be included in the AYMTA Teacher Listings and in the Worldwide Directory of Members Teaching Yangjia Michuan Taijiquan, please provide a reference who is an AYMTA Teacher Member, or arrange to attend a workshop with an AYMTA Teacher Member; if this is not feasible, you may submit a videotape of yourself performing elements of the form, 13 postures, weapons to the Secretary; this criterion for being listed as an AYMTA teacher is designed to ensure YMT as handed down by Wang Yen-Nien is being taught. It is not intended to judge quality of performance..

Annual Fee for January - December 20
Regular Member US $35 x years
US $
Family Member US $20
Name of Regular Member
US $
Student Member US $ 20
Attach proof of fulltime student status
US $
Donation
US $
Total Enclosed
US $

Applicant's SignatureDate
______________________________________________________________________

FOR AYMTA USE ONLY

Date Received ______________________________ Member # ________________

Check # ___________________________________ Effective Date of Membership _______________