Name:
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Address:

City: State:

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Home Phone #: Work Phone #:

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Dojo: Sensei:

Karate Rank: Kobudo Rank:

Member Fees: $40.00 Non-Member Fees: $50.00

Method of Payment: Check by Mail: Credit Card :

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Emergency Contact:

Contact Phone:

* If you are paying by credit card we will call you to obtain your
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TBA
   
   
   
   
   
   
   
   
   
     
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1665 S. Rancho Santa Fe Rd. #A
San Marcos, CA 92078 - USA
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