BECOME AN AFFILIATE — Demian Maia

AFFILIATION PROGRAM

If you are interested in becoming an affiliated academy, please fill out the form and please allow a window of three to five business
for a reply.

Academy Name

Academy Website

http://

Academy Instagram

Head Instructor's Name

First Name

Last Name

Head Instructor's Belt

Number of Students

Have you ever been affiliated with other association?

Yes

Do you compete?

yes

If yes, what Team do you compete for?

Email Address

Phone

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Additional Info: