11th ANNUAL BUSHIKAN SEMINAR
NOVEMBER 14~15, 2014


* Name:
* Last Name:

Address:

City: State:

Zip Code: Country:

* Home Phone #: * Work Phone #:

* E-mail:

Dojo: Sensei:

Karate Rank: Kobudo Rank:

Attending Days: November 15 November 16

Member Adult Fees: Adults, Jr. Black Belt & Brown Belt $135.00

Member Children Fees: White~Green Belt: $65.00

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

Non-Member Fees: Additional $25.00

Total Amount:

Method of Payment: Check by Mail: Credit Card :

Illness/Injuries?

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
Phone:
(760) 744-5560
 
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Bushikan Budo Kyokai

Matayoshi Kobudo Kodokan Intl.

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