Affiliate Questionnaire

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

What is your martial arts & JuJitsu experince including ranks and/or Self-defense and Use of Force Certifications *

How did you hear about us? *

Are you willing to opperate your group as a Business *

What does Japanese Japanese Ju-Jitsu mean to you? *

Are you or have you ever run any Ju-Jitsu programs? *

Is becoming a fully licensed blackbelt instructor a goal of yours? *

Do you own a school or academy? Name? *

Do you have a website and if so what is it? *

Please check -Are you willing to? *

Visit our Vancouver Dojo Host yearly seminars Do online training Skype seminars

If you are not a dojo owner do you have area to train that is safe, clean and has mats *

Yes No Able to find

Is teaching Martial Arts or running an academy your primary job? *

What is your Occupation? *

How many students will be in the group? Select One *

Are you interested in visiting Japan? *

Can your group contribute a capital investment towards monthly association dues? If so what is your budget? *

Are you interested in? Choose Any *

Formal KoKoDo JuJutsu training Formal KoKoDo Shiatsu training Sadohana Self-Defence Training

Do you have any comments for Hanshi? *

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