Yearly Registration Fee: $80.00 for first martial
art. From second art $40.00 for each martial arts
All Chapter Instructors must fulfill the following
requirements in order to qualify for renew.
-
No Criminal Conduct or Immoral Behavior
Yes [] No [] If yes, explain in
detail__________________________________________________________________________________
-
No Drug or Alcohol Abuse
Yes
[] No [] If yes, explain in
detail__________________________________________________________________________________ Additional Martial Arts add with this registration:_________________________________________________
Name of Martial Arts, Degrees, Date, Month and Year.
_______________________________
OHTC Chapter No: ______________________________________________________________________ Name of Instructor:
_____________________________________________
E-Mail
Address:
_________________________________________________
Please answer the following questions regarding your
annual registration.
1. Since your last registration or
submission of your certification not including investigations and disciplinary
actions by OHTC, are there any pending investigations, disciplinary matters,
or final disciplinary actions against you by any licensing agency or martial
arts entity?
Yes [] No []
2. Since your last registration or
submission of your certification, have you been arrested, fined (more than
$100.00), charged with or convicted of a crime, indicted, imprisoned, placed
on probation, or received deferred adjudication?
Yes [] No
[]
3. Since your last registration or
submission of your certification, do you have any condition or behavior,
including, but not limited to any physical, mental or emotional condition,
which has impaired, which could impair your ability to practice as an
Instructor in a competent manner?
Yes []
No []
I certify that the information which I have provided
on this application is correct. I further understand that if this
application has not been completed in every detail, OHTC is not authorized to
issue my Chapter Certification. I further understand that it is a
violation of the OHTC rules and regulations.
By entering your name below your are submitting
your authorized signature.
SIGNATURE:
_____________________________________________
DATE:
_________________________________________
Registration fee and application must be received on or before
1/31 of each year. Failure to keep your chapters permit will result in
cancellation of your certification. This payment renews your
certification for one year. Payments may be made by check, money order
or credit card. Checks or money orders must be payable through a U.S.
bank.
___________________________________________________________________________________
____________________________________________________________________________________
