Membership Application

Professional Karate CommissionPROFESSIONAL KARATE COMMISSION

Membership Application

Please allow 3-4 weeks for processing. New Members will receive a membership card, certificate, and PKC patch. Lifetime members will receive a special gold certificate, laminated membership card, 2 Lifetime Patches, and a gold Lifetime lapel pin. If you do not have a credit card and would like to become a member... simply fill out the form below leaving out the credit card information, print the form & mail it with your check or money order payable to Glenn Keeney mail to:PKC Headquarters...P.O. Box 20936, Hot Springs, AR 71903

Please fill in form completely **are required fields.
Name**
Date of Birth**
Email address**
Phone Number
Street Address**
City**
State**
Zip**
Your current rank**
School/Dojo Name**
Dojo Address (Street/City/ST/Zip)
Style of Martial Arts
Applicant's Instructor**
Member Fees:** $40 New Member $25 Renewal $200 Lifetime Member
Credit Card**
Card Number**
Cardholder**
Expire Date**
3 or 4 digit code**
Billing Zip Code**
The information contained in this application is true and accurate. I understand that falsification of any of this information will result in the immediate suspension of my participation in the Professional Karate commission’s (PKC) Associated School Program. Click Submit or Mail Completed form to: PKC Headquarters P.O. Box 20936 Hot Springs, AR 71903 PKC@PKCHQ.COM
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