NATIONAL JU JITSU FEDERATION
NATIONAL HEADQUARTERS
c/o SHO DAI SOKE D. E. CHASE
111 BELMONT AVENUE
PATERSON, NEW JERSEY 07522
1-800-944-1321
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 111 Belmont Avenue Paterson, NJ 07522. All Money Orders are to be
made payable to: D. E. Chase
Full Name
Date of Birth
E-mail address?
Street Address
City
State
Zip Code
Phone Number
Dojo
Street Address
City
State
Zip Code
Sensei
Sensei's Dan Rank
Ryu/Style
Your Current Ranking
Your 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 ($25.00each)
Black Belt Certification Fee ($100.00per Certification)
Affiliate School Charter Fee ($50.00 Lifetime Registration
per location
)
Affiliate Organization Fee ($100.00 Annual)
Dojo/Organization
Street Address
City
State
Zip Code
Ryu/Style
Instructor Certification (Lifetime Registration)($50.00)
Shidoshi - 1st Dan thru 3rd Dan
Sensei - 3rd Dan or higher
Master Instructor Certification (Lifetime Registration)($250.00)
Renshi - 5th Dan
Shihan - 6th Dan
Kyoshi - 7th Dan
Hanchi - 8th Dan or higher
Sokeship Recognition ($350.00)(Lifetime Registration)
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.
Total Cost:
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
111 BELMONT AVENUE
PATERSON, NEW JERSEY 07522
1-800-944-1321