Individual Membership

First Name *
Middle Initial
Last Name *
Date of Birth *

As of today's date, are you at least 18 years old? *

  • Yes
  • No (If No, please visit our FORMS section and download the Consent Waiver, complete, and return to us at
Address 1 *
Address 2
City *
State *
Zip Code *
Telephone Number *
Email Address *
Did someone refer you to USA Jiu Jitsu? * Yes, No

If yes, you must provide the member's full name (First and Last) in order for them to receive credit.

First Name
Last Name (if known)
Member ID#
USA Jiu Jitsu's membership database will only show your membership card, which includes your photograph that you submit, your name, belt rank (if applicable), and membership number.
Upload Photo

Please upload a photograph that clearly shows your face.

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Disciplines (You can enter up to three ranking and disciplines)
First Last Name

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