100 Days To Blue Belt Application

Please take your time in filling out this application. This experiment is going to REVOLUTIONIZE the way people learn Jiu-Jitsu.

* Indicates required field

Name *

First

Last

Gender *

Height & Weight *

Birthday *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Why do you want to be a part of this experiment? *

What is your athletic/martial arts background? *

Do you have children? *

What is your education background? *

occupation *

Do you have any health conditions or concerns? *

Will you be able to dedicate a MINIMUM of 1 Hour per day to study/training? *

What do you hope to gain from this? *

How do you handle failure/defeat? *

Will you be OK with the attention this experiment gets? *

Are you comfortable on camera? *

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Eddie Fyvie Jiu-Jitsu Academy