Registration form: Introduction to soft power of Goju Ryu with Izumigawa Katsuya (泉川勝也) Sensei
This pre-registration form will help us make plan and address any needs prior to the workshop.

*Please note each person will be required to sign a release form prior to training for this program.
Email address *
Name *
Age (under 18 allowed with a guardian present for the full class) *
Address *
Home Dojo *
Emergency Contact (Name) *
Emergency Contact (Phone) *
Photo/Video Release
I hereby grant the Bond Street Dojo permission to use my likeness in photographs, video or other digital reproduction in any and all of its publications, including website entries, without payment or any other consideration. I understand that any photographs/videos/digital reproductions using my likeness may be used for promotional and/or informational purposes. I make this agreement on behalf of myself, my heirs, successors, executors, estate, and dependents.

By clicking on "Accept", I am asserting agreement and that I am over 18 years of age, and that I am an adult.
Photo and video release *
I have registered with the Paypal link: *
Paypal Link also available on our website event page if needed:
Please note each person will be required to a sign release form prior to training for this program.
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