Official Home of Pai Lum Tao

Yearly Renewal

Membership Online

Society # (if known)

If you do not know, leave blank.

Name *

First Name

Last Name *

Last Name

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Contact Phone Number *

Contact Email Address *

Birthday *

Birthday date (31) *

Birthday date (30) *

Birthday date (29) *

Primary Instructor *

Discipline / Rank

Kung Fu *

Kenpo *

Tai Chi *

San Shou *

Membership Level *

Sidi / Student ($30)

Sihing / Assistant Instructor ($50)

Sifu / Instructor ($50)

School Owner ($100)

Please provide the name of your school *

Please provide school address for the online directory *

Please provide school address for the online directory

Please provide school address for the online directory

Please provide school address for the online directory

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country