2016 East Central Steve Johnson Memorial Kendo Tournament Registration Form
This form is replacing the dojo registration lists from previous years. Please fill out completely for each participant. Entries submitted after October 21, 2016 will incur a late fee. If you have any questions, please contact Jyoshu Tsushima at tsushimaj@gmail.com.
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Gender *
Address *
Address, City, State, ZIP code
Your answer
Rank *
Dojo Name *
Your answer
Phone Number *
Your answer
Email Address *
(For confirmation)
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Medical conditions?
Your answer
Divisions *
Select all that apply. Divisions are subject to change based on the number of participants.
Required
Number bento lunch boxes for Saturday ($10 each)? *
Your answer
How many people will attend the Saturday dinner party?
8:00 pm at Bonchon Chicken, 3586 W Dublin Granville Rd, Columbus, OH 43235
Your answer
I acknowledge that the purpose of this form is for the preparation of the 2016 ECUSKF Johnson Cup. Before the participant named in this form is confirmed for the 2016 ECUSKF Johnson Cup, a waiver of liability signed by participant, a $35 participation fee, and all bento fees must be received by Jyoshu Tsushima at the address below. *
Required
Make all checks payable to "ECUSKF"
All payments and liability waivers must be sent to:

Jyoshu Tsushima
8323 Bruntsfield Road
Columbus, OH 43235

All items must be submitted and postmarked by October 21 to avoid the $5 late fee. No entries will be accepted after October 28.

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