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PEKITI

TIRSIA

KALI

1/15

Welcome

STUDENT APPLICATION

I would like to commit to any of the following progams:

In-Person Class (1.5 hr), 4 weeknights per month

Virtual (Zoom) Class (1 hr), 4 weeknights a month

Virtual Mentorship (1 hr), schedule varies

Access to Visualizing Flow videos, for book owners

I have combat training experience:

Yes

My current classification is:

Active Duty Military

Active LEO

Veteran

Professional

Student

I found out about this training group through:

Social media

Search engine

Referral

I have martial arts training experience:

Yes

Tell us about your martial arts experience. Please indicate name of training style or program, years of training, name of instructor, location of training (N/A if not applicable).

In the last 7 years, have you been arrested for, charged with, or convicted of any offense(s)?

Yes

In the last 7 years, have you been involved in the illegal purchase, manufacture, trafficking, production, transfer, shipping, receiving, or sale of any narcotic, depressant, stimulant, and/or hallucinogen for your own intended profit or that of another?

Yes

Have you been engaged in subversive or terrorist activities? Are you a member or representative of a terrorist organization?

Yes

After submitting this form, I will sign theAgreement and Waiver Form.

After submitting this form, I will sign theMedia Release Form.

I have read and agree to the Terms of Use.

I consent to having this website store my submitted information.

Before submitting this form, please upload a copy of your driver's license.

Upload ID Card

Max File Size 15MB

Congratulations!

Your application has been submitted for review.

Please remember to submit the following:

Agreement and Waiver form and Media Release form.

Do not submit payment until receipt of approval notification. This process may take 5 to 7 business days. Thank you!

An error occurred. Please review the form and make sure that all fields are marked.

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