May 20~22, 2016

* Name:
* Last Name:


City: State:

Zip Code: Country:

* Home Phone #: * Work Phone #:

* E-mail:

Dojo: Sensei:

Karate Rank: Kobudo Rank:

Attending Days: May 20 May 21 May 22

Member Adult & Black Belts Fees: $135.00

Member Children Fees:

White~Green Belt: $50.00 * Brown Belt $85.00

Member Pee-Wee Fees: Pee-Wee: $20.00

Non-Member Fees: Additional $25.00

Late Fees: After May 1, 2016 Additional $25.00

Saturday Lunch: Number of Persons: at $5 each:

T-Shirts: Quantity: Size: at $18 each:

Total Amount:

Method of Payment: Check by Mail: Credit Card :


Emergency Contact:

Emergency Contact Phone:

* If you are paying by credit card we will call you to obtain your
information and confirm your registration.



e-mail: fs@bushikan.com
1945 S. Rancho Santa Fe Rd. #D
San Marcos, CA 92078 - USA
(760) 744-5560
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Bushikan Budo Kyokai

Matayoshi Kobudo Kodokan Intl.

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