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上原合氣修練道場申込書
Registration Application Form - Uehara Aiki Shuren Dojo
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* Indicates required question
氏名(漢字)
*
Full name
Your answer
氏名(ふりがな)
Furigana for Japanese names
Your answer
性別
*
Gender
女性 (Female)
男性 (Male)
生年月日
*
Date of birth
MM
/
DD
/
YYYY
電話番号
*
Telephone number
Your answer
メール (メーリングリストで利用)
*
Email address
Your answer
住所
*
Address in Japan
Your answer
合氣道の経験は何年ですか
*
How many years training Aikido?
Your answer
お持ちの級・段
*
Your current grade?
Choose
6段 (6 Dan)
5段 (5 Dan)
4段 (4 Dan)
3段 (3 Dan)
2段 (2 Dan)
1段 (1 Dan)
1級 (1 Kyu)
2級 (2 Kyu)
3級 (3 Kyu)
4級 (4 Kyu)
5級 (5 Kyu)
6級 (6 Kyu)
7級 (7 Kyu)
8級 (8 Kyu)
無級 (No Kyu)
上記の級・段は岩間神信合氣修練会のものですか
*
Is your current Grade from Iwama Ryu?
はい
いいえ
所属道場
*
Your original dojo up to now?
Your answer
その他
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