Association Application Form • Lucas Lepri Brazilian Jiu Jitsu

Name*

First Last

Academy Name*

Position

Academy Owner's Full Name (If Different From Above)

First Last

Email*

Phone*

Academy Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Academy Phone*

Academy Website*

Years / Months Open

Programs Offered*

Name of Head Instructor of BJJ Program*

Current BJJ Rank of the Head Instructor*

Which Association or Instructor is Currently Ranking Your Students?*

Number of BJJ Students*

Please enter a number greater than or equal to 1.

Is Your Academy Currently Part of An Association?*

Which Association?*

If You Are Currently With An Association, Why Are You Looking to Change?

Additional BJJ Instructor Names and Current Ranks

What BJJ Academies And/Or Associations Are Close By? (Competitive Academies)

Please Give Us A Synopsis of Your BJJ Career From White Belt to Present Day*

Please Give Us A Synopsis of The Head BJJ IInstructor's Career From White Belt To Present Day (If It is not yourself)

Do You Have Any Personal Liens, Judgements or Insurance Claims Against You?*

Please Explain The Situation*

Does Your Business Have Any Liens, Judgements or Insurance Claims Against It?*

Please Explain The Situation*

Selected candidates for the Lucas Lepri Association will be subject to a criminal background check.

EIN# (Employer identification number)

Any Additional Questions or Information?

Comments

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