14th ANNUAL MKKI NATIONAL GASSHUKU
February 21 ~ 23 , 2014


* Name:
* Last Name:

Address:

City: State:

Zip Code: Country:

* Home Phone #: * Work Phone #:

* E-mail:

Dojo: Sensei:

Karate Rank: Kobudo Rank:

Attending Days: Feb. 21 Feb. 22 Febr. 23

Member Fees: Adults $200.00 Children $95.00

Non-Member Fees: Additional $50.00

Late Fees: After Feb. 10, 2012 Additional $25.00

Saturday Night Dinner: Number of Persons: at $25 each:

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

* 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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