Black Belt Information Questionnaire

If you are the person listed, and you have reached this page, we need more information on you to complete your personal page.

(This information is to be completed by members who have completed their black belt testing only!)

Please provide the following contact information so we can verify your entry.  This information will not be included on the website, but must be provided before we can include your personal page. 

   Full Name: 

  Email Address:  

  Telephone Number (including area code): 

  Mailing Address: 

The following information will be used to write a short biography of all Black Belt members for the school’s web page, which is being designed. You can view it at http://houma-omac.com

  If you have a digital picture of yourself in your uniform, please email it to rmarcel@houma-omac.com

  1. What is your name? 

 

  1. In what city, state do you live?  

 

  1. What is your age and birthday?   

 

  1. Are you married?                    How long?   

 

  1. Do you have children?    How many? 

            Do you have grandchildren?            How many? 

 

  1. What was the date of your last Black Belt test?    What rank?

 

  1. What school do you attend?       What grade? 

     If you are in college, what is your major?    

  1. Where do you work? 

      What is your job title? 

 

  1. What are your hobbies? 

 

  1. What are your goals in Tang Soo Do? 

 

  1. Provide any other information that you would like to include.

 

 

     If you have a picture of yourself in uniform that you would like to be used, please put your name on the back and         bring it to Master George, so that it can be scanned and used on the website.  It will be returned to you.  We will      also be taking pictures during classes and promotional tests to use on the web site. 

    If you have a digital picture of yourself in your uniform, please email it to rmarcel@houma-omac.com