FIMA Black Belt Application

MUST BE A MEMBER OF FIMA TO APPLY FOR BLACK BELT DAN RECOGNITION. ALREADY A FIMA MEMBER, THEN PROCEED. IF NOT YET A FIMA MEMBER SELECT FIMA MEMBERSHIP TO APPLY, THEN COMPLETE THIS FORM.
Organization Name*
Applicant Information
First name*
Last name*
FIMA member #*

Disclaimer
Consent*
I have read and agree with the disclaimer
Please accept my application for Black Belt in the Federation of Israeli Martial Arts. I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information in my application may result in discontinuation of membership. All Black belts may apply for Recognition License for initial Black Belt certification. Upon completion of a FIMA-sanctioned workshop, seminar, or course, members with Black Belt Recognition Certificates may apply for FIMA Black Belt Status. Dan Recognition certificates will only be issued up to 3rd Dan. Above 3rd Dan, please contact headquarters. FIMA Black Belt Certificates may be issued to any member in good standing who has trained and certified as a 1st Dan to 9th Dan Black Belt.
Date*
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Applicant Information