Facilitator Training Program Application

Please read through the web page entitled, “Becoming a Certified Facilitator of The Samurai Game®,” before completing this application. Also, please note that applicants must have participated in at least one Samurai Game® prior to acceptance in the Facilitator Training Program.

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Step 1 of 3

Contact Information

First Name*

Last Name*

Your Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Phone Number*

Other Phone Number

Email*

Website

Facebook URL (Professional account)

Instagram URL (Professional account)

LinkedIn URL (Professional account)

Tell us about your work...

Your Occupation*

Company Name

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is your position with this company?

Years with the company?

What does the company do?

The Samurai Game is a Registered Trademark. Format, flow, activities, characters, character staging, and script lines are fixed in the form of writing and recording and constitute intellectual property copyrighted and owned by Samurai Game Associates, LLC. All rights reserved worldwide. All productions of The Samurai Game, including those delivered as adaptations, with title changes, or character name changes, and all derivatives are covered by copyright and require pre-production written approval from Samurai Game Associates, LLC.

Facilitator Training Program Application

Contact Information

Tell us about your work...

Tell us about your experience and interest in The Samurai Game®...

Tell us about your personal or professional experience that may be relevant to your successful facilitation of The Samurai Game®...

Please provide names, email and phone numbers of three professional references:

Additional Information