AFJ STUDENT APPLICATION

AFJ INSTRUCTORS: Please use print and use this form for your students rank certification (with a blue and red yin-yang). Please send this registration and include $15 per certificate to:

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

Instructor’s Name___________________________________________________

Instructors Mailing Address___________________________________________

_________________________________________________________________

Style_____________________________________________________________

Month and Year of Test______________________________________________

Students Name___________________________________________________

Students new Rank _________________________________________________

Students Name___________________________________________________

Students new Rank _________________________________________________

Students Name___________________________________________________

Students new Rank _________________________________________________

Students Name___________________________________________________

Students new Rank _________________________________________________

Students Name___________________________________________________

Students new Rank _________________________________________________

Students Name___________________________________________________

Students new Rank _________________________________________________