Contact us.theblindninjaprojectinc@gmail.com(619) 865-001997 Bark Ave.Central Islip, NY 11722 Name * First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Are you a veteran? * Yes No Preferred Martial Art * Do you currently attend a martial arts program? Yes No If Yes, please list name and contact info of the gym. May The Blindninja Project Inc. use media from your training? Yes No Would you like to share your story on The Blindninja Project Inc. website? Yes No Are you will to fundraise $1,500 over the course of 12 months? Yes No The following are open ended question to better know you. What is your physical disability? How did you hear about The Blindninja Project? Why do you think you would benefit from martial arts? How can The Blindninja Project improve your quality of life by supporting your martial arts goals? By digitally signing below, you are confirming the above statements are true, and that you agree to be sponsored as an athlete by The Blindninja Project Inc. * First Name Last Name State ID Number * Thank you!