AIKIA Application for Black Belt Instructor/ School Charter

(Taekwondo/Karate/Tangsoodo/Hapkido/Kickboxing) $99 (Onetime fee)




(Name)            (Date of Birth)        (e-mail address for receiving newsletter)




(Street address)(Apartment or P. O. Box number)



(City)            (State)                      (Zip code)                                           (Phone number)


In _________ (year) I received the 1st degree black belt from my instructor ___________________________________ (name of instructor) whose school was/is located at _______________________________________________________________________ (address of school). (Include a copy of all black belt certificates. Any misinformation may result in forfeiture of your application fee of $99).


____________ Enclosed is my one time application fee of $99 (please add $10 shipping fee for large envelope). I understand I will receive the Aikia Black Belt Lifetime membership certificate, Aikia Black Belt Instructor certificate, and the Aikia Dojo Marketing book. I receive a free download link of the book manuscript Joe Lewis American Karate Systems by Joe Lewis and Dr. Jerry Beasley (first published as The Greatest Karate Fighter of All Time by Paladin Press, 1998) and a free download of the book manuscript for JKD: High-Risk Sparring by Dr. Jerry Beasley featuring Joe Lewis (published by Unique publications, 2008. I will be able to offer Aikia student rank certification and life memberships at a 50% plus profit sharing. In Aikia you get the respect and you make the profit.


AIKIA STUDENT MEMBER: Not a Black Belt? You can still enjoy the benefits of worldwide rank accreditation for the nationally advertised lifetime student membership fee of only $39 ($19 through an Aikia certified training center). Lifetime student members are eligible for National Rank Registration and Accreditation for only $6.99 per kyu/gup. Send us a copy of your current rank certificate and fee. We will send you the Aikia members only card with your name and official rank noted.


For questions, write:


P. O. Box 402
Christiansburg VA  24068