15th ANNUAL BUSHIKAN SEMINAR
October 12~13, 2018


* Name:
* Last Name:

Address:

City: State:

Zip Code: Country:

* Home Phone #: * Work Phone #:

* E-mail:

Dojo: Sensei:

Karate Rank: Kobudo Rank:

Attending Days: May 19 May 20 May 21

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, 2017 Additional $25.00

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.

 

 


* Name:
* Last Name:

* Address:

* City: * State:

* Zip Code: * Country:

* Cell Phone #: Work Phone #:

* E-mail:

Dojo: Sensei:

Karate Rank: Kobudo Rank:

Attending Days: Oct. 12 Oct. 13

Member Adult, Brown Belts & Black Belts Fees: $135.00

Member Children Fees:

WHITE~GREEN BELT $65.00

Pee-Wee Fees: $20.00

Non-Member Fees: ADDITIONAL $25.00

Late Fees: AFTER OCT. 1, 2018 ADDITIONAL $25.00

Saturday Night Dinner: NUMBER OF PERSONS: AT $30 EACH:

T-Shirts: QUANTITY: SIZE: AT $18 EACH:

* Total Amount:

Illness/Injuries?

Emergency Contact:

Emergency Contact Phone:

CLICK ON SEND TO MAKE A SECURE PAYMENT

 

 

   
   
   
   
   
   
   
   
   
     
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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