MANDE MUDA MEMBERSHIP

Application

This membership was created by Pak Herman as a way of connecting people to information about Pencak Silat, in general, and more specifically about Mande Muda and the various arts of Pencak Silat that come from West Java.

Money raised through these memberships will be used to support the activities of The Suwanda Academy International, which was organized by Pak Herman in 1999. The organization will help to supervise the training programs in the West and assist Ibu Rita and other family members with the planning and funding of their seminars outside of Indonesia. It will also work to develop programs for silat competition in traditional and modern silat in the US and assist the clubs in Europe where competitions are already established

DATE:______________

Personal Information:

Name:______________________________________ Phone#:(_____)__________________

Work#:(____)____________________ Fax#:(_____)__________________

Address:_______________________________________________________________________

City:____________________________________State:_________________Zip:_______________

Email:________________________________

Country: _________________________Country Code: _________________

Occupation:______________________________________Birthdate:__________________________

1. Medical conditions or physical limitations that may affect your training:___________________________________________________________________________

2. Do you own or run a Martial Arts studio? __________

Name of Studio/facility_______________________________________________________________

3. Do you teach or are you an Instructor? _____________

What styles?_______________________________________________________________________

4. What is your Martial Arts background? Who were your teachers, what dates, length of time?_____________________________________________________________________________

5. What is your interest and/or goal in joining the Membership?

______________________________________________________________________

(Provide your answers on the back of this or on another piece of paper, printing clearly and legibly, Thank you.)

6 Of what style(s) of Pencak Silat are you knowledgeable?____________________________________________________________________

7. How did you first hear about Mande Muda and the Suwanda Academy?________________________________________________________________________

8. Regarding Pencak Silat in general and/or Mande Muda: What questions or general interests do you have?___________________________________________________________________________

Membership benefits include:

1. Members only video

2. Membership Card

3. 10% discount on Indonesian camp fee excluding airfare & taxes

(discount is based on price of camp after airfare at time of ticket purchase for camp, taxes not included)

4. Merchandise discounts for members from $2-$25 and sometimes more.

TO JOIN:

Please send payment and this application, along with any additional information you would like to provide, including any questions you would like to submit for answers in the Newsletters.

Membership cost per year: $50

Outside US add $6 USD for shipping and handling.

Arrangements can be made to wire payments by Western Union or make check or money-order payable to:

K.R. Dority

4409 Evenstar Way

Plano, Texas USA 75074

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