* Name: * Last Name: Address: City: State: Select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexio New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennesee Texas Utah Vermont Virgina Washington West Virgina Wisconsin Wyoming Zip Code: Country: * Home Phone #: * Work Phone #: * E-mail: Dojo: Sensei: Karate Rank: Kobudo Rank: Attending Days: Oct. 16 Oct. 17 Oct. 18 Oct. 19 Member Fees: 3~4 Days $185.00 * 1~2 Days $145.00 Non-Member Fees: Additional $25.00 Late Fees: After Oct. 1, 2008 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: Contact Phone: * If you are paying by credit card we will call you to obtain your information and confirm your registration.