Name:

Date of Application:

Street Address:
City:
State:
Zip:
Country:

Phone #:

Date of Birth:

E-mail:

Martial Arts Style:

Current Rank:
(photocopies of your most recent rank in all styles of martial art must be included with your application)
 

Your School Name:

School Address:

School Phone:

Head Instructor of School:

Grandmaster or Style-Head of Your System:
 

MEMBERSHIP REQUIREMENTS  Membership into PACHIVAS PANKRATION is open to any martial artist that possesses certified, authentic rank from a recognized organization.

MEMBERSHIP DUES - a $35 gift gives you LIFETIME MEMBERSHIP!!!

OFFICIAL SCHOOL AFFILIATION CERTIFICATION - $250 (Chief Instructor of the
school must be enrolled in the Instructor Certification Program for PACHIVAS PANKRATION.  Each school is independently ran and operated. The USKA does not tell you what to teach or when to teach it.

INSTRUCTOR CERTIFICATION - There are a great deal of specific requirements to test into the Instructors Program. Based upon years in training, competition record, and rank in the martial arts, individuals may qualify for an Instructors level without going through all levels of rank. If you
are interested in Instructor Certification you MUST contact JOHNNY RUSSELL at the address below, and information will be made available to you .

  ALL PROMOTIONS & RANK CERTIFICATION IS SUBJECT TO APPROVAL OF DIRECTOR
 
 

Print this application and mail it to: