![Text Box: MARTIAL ARTS RETREAT CENTER
Registration Form
SEMINAR TOPIC: __________________________________ Seminar Date: ____/____/____
Early Registration: (postmarked 3 weeks prior to Seminar date):
[ ] Association Member: $245.00
[ ] Non-Member: $275.00
Group Registration: (mail all forms and payments in same envelope)
[ ] Member: $220.00 per person
[ ] Non-Member: $250.00 per person
Total # of persons in group: _____
Late Registration:
[ ] Association Member: $260.00
[ ] Non-Member: $290.00
Name: _________________________________________________Birth Date: ___/___/___
Rank: ______________________________Member #:______________________________
Address: ___________________________________________________________________
City: ________________________________State:________________ Zip:______________
E-Mail: __________________________________Tel: ( )_________________________
[ ] Male [ ] Female
Tee Shirt Size: [ ] Small [ ] Medium [ ] Large [ ] X-Large
[ ] I will be bringing my own equipment. [ ] I will need to purchase equipment.
Please list any physical or dietary needs. (Use back of this form)
Method of Payment:
Check #________ Money Order #____________
Total Payment: $____________ Date: ____/____/____
Signature: ___________________________________________________
Copy this form and mail with payment to (call first for availability):
Zenkoku Ryukyu Kempo Karate-Do Renmei
P.O. Box 537, Morriston, FL 32668-0537
Phone: (352) 528-4890](registration_files/image001.gif)
Go to Seminar Calendar or contact us at info@ryukyukempogeraldi.org for information on Seminars that are now being offered!
(Call (352) 528-4890 first for availability, then copy form and mail-in with payment )
Copyright © 2005 Zenkoku Ryukyu Kempo Karate-Do Renmei. All rights reserved.