ONE REGISTRATION PER PERSON
* Name :
* Last Name :
* Address :
* City :
* State :		Select a state Outside the USA 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 :
* Cell Phone # :
* Work Phone # :
* E-mail :
Emergency Contact :
Emergency Phone #:
Illness/Injuries? :
MARTIAL ARTS INFORMATION
* Karate Rank :
* Kobudo Rank :
Dojo Name :
Dojo Instructor :

GASSHUKU PAYMENT
(*) Fees are not refundable
Full Payment :			$5,100.00
Down Payment :			$500.00
Partial Payment :
Non-Member :			$200.00
Extra T-Shirt Qty :			$18.00		Size :
Gasshuku Amount :
DONATION TO BUDO CENTRE
How is my donation going to be used? Please click here
Donation :
Total Amount :

CLICK ON SEND TO MAKE A SECURE PAYMENT