RANK ADVANCEMENT PRINTABLE FORM

DO NOT SEND THIS PAGE IF YOU ARE NOT A REGISTERED AFJ INSTRUCTOR Print and send this application to the address below, if you are already an AFJ member and are advancing in rank (for either time in rank advancement or test advancement). To receive your AFJ Certificate (with a blue and red yin-yang), print this form page, fill it out and send it with your $40 Instructor Registration fee to:

American Federation of Jujitsu®
1225 Felmey Road
Winfield, PA 17889 USA

Name ____________________________________________________________

*Requested Rank __________________________________________________

(*Standard AFJ format example: Nidan, 2nd Degree Black Belt.)

**Style:__________________________________________________________

(**As you would like to appear on your certificate, be sure and double check for spelling and capitalizations. (not all capital letters)

NOTE: ONLY ONE STYLE PER APPLICATION

Number of years after you’ve received your First Degree Black Belt

Are you the Founder of this system? . YES . NO ___________________________

If your are the founder, please include your system’s belt requirements

Mailing Address ____________________________________________________

_________________________________________________________________

_________________________________________________________________

Email Address______________________________________________________

Date of Birth_______________________________________________________

School Name (optional) ______________________________________________

Your web site (optional) _____________________________________________

Please write brief outline of your Martial Arts activities since your last promotion.