BELT ORDER FORM
WORLD TANG SOO DO ASSOCIATION
709 Oregon Avenue, Philadelphia, PA 19148
Phone: 215-468-2121; Fax: 215-336-2121; Email: WTSDA@aol.com

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BELTS 0 1 2 3 4 5 6 7 Instructor Student TOTAL
Orange $3.00 $5.00 $
Green $3.00 $5.00 $
Brown $3.00 $5.00 $
Red $3.00 $5.00 $
Navy $3.00 $5.00 $
Black $5.00 $10.00 $
White/Orange N/A $3.25 $5.25 $
Orange/Green N/A $3.25 $5.25 $
Green/Brown N/A $3.25 $5.25 $
Brown/Red N/A $3.25 $5.25 $
Red/Blue N/A $3.25 $5.25 $
Blue/Black N/A $3.25 $5.25 $
Tiny Tigers 00 0 1 2 3 Instructor TOTAL
White w/ orange stripe $2.50 $
White w/ green stripe $2.50 $
White w/ brown stripe $2.50 $
White w/ red stripe $2.50 $
White w/ blue stripe $2.50 $
Little Dragons 00 0 1 2 3 Instructor TOTAL
Yellow w/ orange stripe $2.50 $
Yellow w/ green stripe $2.50 $
Yellow w/ brown stripe $2.50 $
Yellow w/ red stripe $2.50 $
Yellow w/ blue stripe $2.50 $
Embroidered Belt
Name: Assoc #: Belt Size: $30.00 TOTAL
$
Sold to:
Ship to:
SUBTOTAL $
DOMESTIC SHIPPING (48 Continental States)
If SUBTOTAL is Less than $50.00 ADD $5.00
If SUBTOTAL is $50.00 or More
ADD 5% (SUBTOTAL x .05) 		$
OVERSEAS SHIPPING
Please call HQ to receive accurate shipping rates 		$
TOTAL $
Date:     Phone:  Email:      
Studio:  Rank:    Assoc. #: 
Payment: Check/Money Order       Visa Mastercard
Name on Card: Expiration:
Card No: 3 or 4 Digit Security Code: