ATERU WORLDWIDE ASSOCIATION

ATERU WORLDWIDE ASSOCIATION
900 Bright Road Findlay, Ohio USA 45840

ASSOCIATE SCHOOL CHARTER MEMBERSHIP

Submission Date ________________ Name of School________________________

Meaning of Name____________________________ Street Address_______________________

City _____________________State/Province___________________ Country____________

Postal Code_________________Chief Instructor (CI) Name _________________________________

(CI) Rank _____________________ School Phone Number____________________

CI Phone number:___________________________ Dojo web site: www._______________________________________

TOP Assistant Instructor(s)/Ranks

1)______________________________________ 2)___________________________________

schedule of classes, dates and times offered

____________________________________________________________________________________________

Total Number of School members including Instructors_____________

First Time Dues: $250 US money order _______________ (Renewable @ $100.00 US)

NOTICE: Shipping this starter kit will be very expensive. Inside US add $10.00 to ship,

$25.00 to ship outside US) All funds must be in the form of a US money order ONLY and made

out to: Ateru Worldwide Association

MAIL FORMS TO: ATERU WORLDWIDE ASSOCIATION
900 Bright Road Findlay, Ohio USA 45840

EMAIL: info@ateruworldwideassociation.com Phone: 1.419.422.9262 “Live like a Samurai”

- ----- - - - - - - - For AWA Headquarters Use Only - - - ------------------------------ - - - - - - - -

AWA Charter & welcome kit sent and Date Membership is Recorded______________