FIMA Black Belt Application Step 1 of 3 33% 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*Please selectICTAIMCOIWASLETAIGDAIMAApplicant InformationFirst name*Last name*FIMA member #* Israeli Martial Arts BackgroundISRAELI MARTIAL ART/STYLENONEKRAV MAGAKAPAPHISARDUTKAVANAHHAGGANAHKALAHOTHERRANK*IF BLACK BELT UPLOAD YOUR CERTIFICATEYOUR INSTRUCTOR NAME*SCHOOL NAME*SCHOOL ADDRESS* DisclaimerConsent* I have read and agree with the disclaimerPlease 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* Date Format: MM slash DD slash YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.