Your Name (required)
Your Email (required)
Last Name Name*
Date Of Birth*
Are you being referred by someone at Nyza Jiu Jitsu?* Yes No
If yes, please mention name and email of the Instructor Person referring you*
Home Phone Number*
Work Phone Number*
Cell Phone Number*
Home Fax Number*
Personal Facebook URL
Country* United StatesChinaHawaii
Is this a new Martial Arts School?* Yes No
If no, How long have has your school been open?*
Does your school have any other Brazilian Jiu-Jitsu Organization affiliation at the moment? Yes No
If yes, please name the Organization
How many students do you have?
Please approximate students population by rank, (e.g., 50% White Belt, 40% Blue Belt, Etc.)approximate students population by rank...
What is your goal in terms of number of students in your Brazilian Jiu-Jitsu Program?goal in terms here...
Is your school in a 20 mile radius of an existing NJJA school? Yes No
If yes, name school address state and country
Name of the head instructor responsible for BJJ program
Rank of the head instructor responsible for BJJ program
Who promoted the instructor responsible for the BJJ program to his current rank?
Please provide active email address of the person who promoted the head instructor to his current rank
What was the date of the instructor's last promotion?
Please provide information on the competition, training and teaching background of the instructor responsible for BJJ Program
Please explain the reasons why you would like to join Nyza Jiu-Jitsu
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