Belt Exams - Gold

You Are Submitting For Your Gold Belt Requirements

Please provide the information requested below and click the "Send Now" button.

First Name

Last Name

MY GOAL

MY GOAL STATEMENT:

MY MAIN OBSTACLE(S):

THE CONSEQUENCE:

MENTAL ACTION STEPS

Mental Action Step 1

Mental Action Step 2

Mental Action Step 3

PHYSICAL ACTION STEPS

Physical Action Step 1

Physical Action Step 2

Physical Action Step 3

MY BUDO BUDDY

Budo Buddy Partner 1

Budo Buddy Partner 2

Budo Buddy Partner 3

MY RESULTS (TAKEAWAYS / INSIGHTS):

MY PERSONAL EXPERIENCE (OPTIONAL):

Start Date

End Date

My Promise:

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ATTACH YOUR BELT EXAM IMAGES: (Max of 10 files no larger than 4MB each please)

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* I understand that the belt exam fee, currently included with my membership, covers the cost of my belt exam Gold - Regularly $30 - I understand that if I would also like a physical wristband belt to symbolize my belt status in real life, I will be able to order one for $1 plus S&H when I pass my exam.