United States Martial Arts Federation

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Martial Arts Leader Survey

Please use this form to tell us a little about yourself and your Martial Arts Activites.

Please note that the information you provide will NOT be released to any outside source, sold, or nor will your privacy be invaded in any way.

Fields with an asterisk * are required.

Name:*
Email:*
Mailing Address:
City:	State:	Zip:

Home Phone:
Work Phone:
Fax Number:
Style or System:
Your Martial Arts Rank:
Your Age:
Years you have trained in martial arts:
Name of your Club or School:
Are you currently affiliated with any martial arts organization? Yes No If Yes, which Organization?
Are you current teaching a Martial Art? Yes No
If you are teaching, how many students do you presently have?
How many Black Belt students do you have?
Would you be interested in providing Leadership to organize a USMAF Regional Organization in your area? Yes No
Would you be interested in serving on the USMAF Board of Directors? Yes No
Is there a particular USMAF Committee or Function you would like to serve on? Yes No
Are you available to travel to USMAF National Events and/or JJIF International Events? Yes No
Are you currently working on any special projects (i.e. community outreach) in your Martial Art(s) system? Yes No
Are you interested in receiving competition Referee Training and becoming a certified USMAF/MAIF Referee? Yes No
Would you be interested in hosting a USMAF Referee Course (12 hour-Weekend) at your Dojo? Yes No
Are you currently conducting or hosting Martial Arts Competitive Events Yes No
Do you have access to facilities that could be used for Martial Arts Competition or Seminars? Yes No If Yes, Please describe:
Is there any USMAF Project that you would like to work on individually or in a Committee Work-Group? Yes No If Yes, Please comment:
Would you like for us to mail you information on USMAF Membership? (If so, please make sure you provided a valid mailing address above): Yes No If Yes, make sure your mailing address is listed above
May we contact you concerning USMAF Membership? Yes No
Do you have any comments or suggestions that would enhance USMAF's growth and service to its Members?
Do you have any other comments or suggestions to the USMAF Board of Directors, President or other Officers at this time?

Please click the Submit Survey button to complete the survey.

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