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
11/31 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.
Method of Payment
Check
Credit Card
Check Information:
If paying by check, please enter check amount and check number .
Credit Card Information:
Check One:American Express Visa
MasterCard
Name On Card:
Card Number: For your security, provide this information
by phone or mail.
Expiration Date: For your security, provide this information by
phone or mail.
I prefer to
call in my credit card number over the phone. (Order will be processed as soon as payment
is received.)
