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NATIONAL JU JITSU FEDERATION
NATIONAL HEADQUARTERS
c/o SHO DAI SOKE D. E. CHASE
P.O. BOX 336
BLOOMFIELD, NEW JERSEY 07003
nationaljujitsufed@yahoo.com
 
RANK RECOGNITION/MEMBERSHIP APPLICATION


Directions: The information requested in this application must be typed or printed clearly. Any illegible information will cause this application to be returned to you and will delat the process in recognizing your rank and issuing your certification(s). This application must be filled out completely and returned with appropriate fees. Any missing information, fees or invalid information will also cause this application to be returned to you. This application must be mailed to the National Headquarters NJJF P.O. Box 336 Bloomfield, NJ 07003. All Money Orders are to be made payable to: D. E. Chase
 
 
Name: _________________________________   DOB: ______________
Age: ______   Sex: _________   Height: __________    Weight: _________
Address:  ___________________________________________________
Home Phone: ____________________   Work Phone: ________________
Dojo: ______________________________________________________
Address:  ___________________________________________________
Sensei: ____________________________   Dan Rank: _______________
Ryu/Style: ___________________________________________________
Current Ranking: ___________________     Rank Date: _______________
 
Please provide photo copies of all Kyu/Dan grades you wish to have certified.
 
CERTIFICATION REQUEST:
___ Annual Membership Fee ($35.00)
___ Lifetime Membership Fee ($125.00)
___ Kyu Grade Certification Fee ($25.00 each)
___ Black Belt Certification Fee ($100.00 per Certification)
___ Affiliate School Charter Fee ($50.00)(Lifetime Registration)
Name of Dojo: ___________________________________________________________
Address: ______________________________________________________________
System/Ryu: ___________________________________________________________
 
___ Instructor Certification Fee ($50.00)(Lifetime Registration)
Please Indicate: ( ) Shidoshi - 1st Dan thru 3rd Dan ( ) Sensei - 3rd Dan or higher 
 
___Master Instructor Certification Fee ($250.00)(Lifetime Registration)               
( ) Renshi - 5th Dan ( ) Shihan - 6th Dan  ( ) Kyoshi - 7th Dan  ( ) Hanchi - 8th Dan or higher
 
___ Sokeship Recognition ($350.00)(LifetimeRegistration)
Please Indicate: ( ) Soke - 5th Dan or higher  ( ) Soke Dai - 9th Dan or higher  ( ) Sho Dai Soke - ($500.00 Review & Recognition Fee) Special Requirements apply. Contact National HQ for details.
 
 
I, __________________________________________, hereby make application for Membership/Rank Certification in the National Ju Jitsu Federation and certify that all information contained herein is true and accurate to the best of my knowledge. I understand that I must renew all annual memberships, charters and/or certifications that I may receive. I agree to conduct my school/club/Dojo in accordance to the rules and regulations of the National Ju Jitsu Federation.
 
 
_____________________________                     ___________________
Signature                                                                 Date
 

NATIONAL JU JITSU FEDERATION
P.O. BOX 336
BLOOMFIELD, NEW JERSEY 07003