A.C.T Program Application Form Name Date of Birth (dd/mm/yy) City State Country Phone Work Phone Email Address Which programs are you interested in? Which programs are you interested in? A.C.T. Introductory course 101 A.C.T. Short Weapon Instructor certificate A.C.T. Long Weapon Instructor certificate A.C.T. Full Coach certificate What do you do? Give a description of your occupation/profession Do you have any previous martial arts, military or security experience? If you do, please describe duration, rank, style and who your instructor was. What is your main area of interest in A.C.T.? Reality-based weapons, Traditional weapons, Self-defense, Security work, etc. 11 + 11 = Submit We will never share any of the information that you share with us and hold it privately.