Union UTA Martial Arts/SAMI UNION: Black Belt candidate order form

Black Belt Candidate

equipment order form

This form covers black belt uniform and sparring equipment

requirements. At this point candidates should already have a pair of Escrima, and 2 pair Nunchuku.

This form will cover uniform requirements, weapons, and sparring equipment.

INFO:

Please note that this form contains limited capacity items which are sold out. They are displayed grayed out and/or are not selectable.

How would you like to pay?

When would you like to pay?

Registrant Fee:		$0.00
Group Fee:		$0.00
Registration Fee:
Quantity Discount:		-
Promotional Discount:		-
Subtotal:
Online convenience Fee:		$0.00
Delayed Payment Surcharge:
Total Fee:

Billing information

First Name

Last Name

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City

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Phone

Billing and Payment
Billing and payment processing for Businesses' events is performed by Member Solutions, Inc. ("MSI"), and this contract is specifically assigned to MSI for all such purposes. Customer knowingly and irrevocably authorizes MSI to charge electronically Customer's bank account and/or credit card for any and all amounts due for Customer's, and anyone registering under Customer's, attendance and participation in the Event. Please note, you may see all or any portion of the following on your bank or credit card statement: "MSI*UNIONSUNITEDTAEKWOND 8882448044 ONLINE REG FEE". Any returned payment will be assessed a $25.00 fee. Any unsuccessful electronic transaction is subject to a $10.00 processing fee. MSI is not responsible for any bank fees incurred by Customer. MSI has the sole right to resubmit returned or declined items (plus applicable fees) without prior notice. BILLING INQUIRIES -- 888-244-8044 or by mail to PO Box 297, Hatboro, PA 19040.

Applicant Agreement
I represent that I am the person who appears on the application above. I acknowledge and agree to the statements, terms and conditions above, as well as any applicable terms and conditions for this registration, and that by typing my name below and completing this registration form, I am electronically signing the document, which will have the same legal effect as the execution of the document by a written signature and shall be valid evidence of my intent and agreement to be bound.

Applicant Signature
Please enter your full name in the space below.

Please click the button below to finalize your registration.

Registration inquiries:
Union UTA office Staff
office_manager@unionuta.com
(908) 687-5559

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BLACK SPARRING GEAR: Choose sizes for the following 4 sparring products-