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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