Minnesota Aiki Shuren Dojo Seminar Registration Form 2015

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Thank you for registering for Minnesota Aiki Shuren Dojo Seminar 2015 featuring Tokusei Takahashi Shihan and Mark Leonard Larson Sensei. The seminar is from Saturday, April 11, to Sunday, April 12, 2015 at St. John's University.
Participants (or guardians) please complete the liability waiver form before participating.

Seminar Fees: Saturday, April 11- $70.00
Sunday, April 12 - $50.00
Both days $120.00
Price for students: $10.00 per day.

Please mail payments to:Charles Wright
Quad 359C
Saint John’s University
2850 Abbey Plaza
Collegeville, Minnesota 56321
U.S.A.

First Name *

Last Name *

Phone Number *

Address *

Are you affiliated with a home dojo? *

Yes

If yes which?

Are you a college or a high school student? *

Yes

If yes where?

I will be paying: *

Please make checks out to "St. John’s University"

At the Door

By mail

Other:

Which days will you attend seminar? *

Note:Students pay $10.00 per day.

Saturday, April 11 (Training Fee $70.00)

Sunday, April 12 ((Training Fee $50.00)

Both days: April 11 & 12 (Training Fee $120.00)

Allergies or Health Conditions

Emergency Contact *

Contacts relation to participant. *

Parent, Spouse, etc.

Contacts phone number *

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