Become an Affiliate

Applicant Information
Name*
First Last
Position*
Academy Owner Name*
(Academy Owner Name if different from the above applicant)
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Academy Information
Academy Name*
*
Academy Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Email
Enter Email Confirm Email
Phone*
Academy Phone Number*
Academy Website*
Years in Business*
Programs Offered*
Number of Students in your BJJ Program*
Average Pricing of your BJJ Program
Instructor Information
Name of Head Instructor*
Name of Head Instructor
First Last
Current Rank of Head Instructor*
Lineage of Head Instructor*
Is your head instructor an active BJJ competitor ?*
Is your head instructor an active BJJ competitor ?
Lineage of Owner
Any Other Martial Arts Experience ?
Current Affiliate Information
Which Association or Instructor is Currently Ranking Your Students?*
Is your academy currently affiliated with another team?*
Is your academy currently affiliated with another team?
Do You Have Any Personal Liens, Judgements or Insurance Claims Against You?*
Do You Have Any Personal Liens, Judgements or Insurance Claims Against You?
Does your Business Have Any Liens, Judgements or Insurance Claims Against It?*
Does your Business Have Any Liens, Judgements or Insurance Claims Against It?
Selected candidates for the Essential Jiu Jitsu Association will be subject to a criminal background check.
Any Additional Questions or Information?