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DYMA Intermediate and Advanced Testing Application
Parent/Guardian Full Name
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Email Address
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Member Full Name
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Birth Date
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What Location Are You From
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Purcellville
Brambleton
TESTING MEMBER
Current Rank
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Yellow Belt
Yellow-Green Belt
Green Belt
Green Belt Blue Stripe
Blue Belt
Blue Belt Red Stripe
Next Rank (Testing For...)
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Yellow-Green Belt
Green Belt
Green Belt Blue Stripe
Blue Belt
Blue Belt Red Stripe
Red Belt (Hi-Advanced)
Testing Date
(Purcellville)Feb. 14th (Fri) (4:20pm-5:00pm)
(Purcellville) Feb. 14th (Fri) Teen & Adult (6:40 pm)
(Brambleton) Feb. 19th (Wed) (4:20-5:10 pm)
(Brambleton) Feb. 19th (Wed) (6:30-7:10 pm)
(Brambleton) Feb. 19th (Wed) Teen & Adult (7:10 pm)
Pricing (NEXT BELT)
Yellow Belt Green Stripe /Green Belt: $65
Green Belt Blue Stripe/Blue Belt/Blue Belt Red Stripe: $75
Red Belt/Red Belt 1 Black Stripe: $85
By signing below, I approve DYMA to charge my credit card on file for this testing.
Signature of Applicant/Parent/Guardian
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Remember: Your every action reflects the honor and integrity of DYMA. Please show respect and follow Taekwondo and DYMA principles. Violation of other's safety will result in forfeiture of rank.