Minnesota Aiki Shuren Dojo Seminar Registration Form 2015
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 *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Address *
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Email
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Are you affiliated with a home dojo? *
If yes which?
Your answer
Are you a college or a high school student? *
If yes where?
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I will be paying: *
Please make checks out to "St. John’s University"
Which days will you attend seminar? *
Note:Students pay $10.00 per day.
Allergies or Health Conditions
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Emergency Contact *
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Contacts relation to participant. *
Parent, Spouse, etc.
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Contacts phone number *
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