Seminar Registration Form 2026 Kanai Sensei Memorial SeminarFull Name *Email Address *Phone NumberAddressPreferred Contact Method:EmailTextEmergency Contact Name: *Emergency Contact Phone Number: *Dojo Affiliation:Chief Instructor:Current Rank:No Rank5th Kyu4th Kyu3rd Kyu2nd Kyu1st KyuShodanNidanSandanYodanGodanRokudanHow did you hear about this seminar?0 / 300Would you like to be contacted for future events?YesNoSeminar Fees:Fees:Members - $50 | Non-Members - $70SelectMembers - $50Non-Members - $70Payment:Please use one of the following methods to send the total amount for your order. Our preferred payment methods are:Total Amount$ Zelle: To pay via Zelle, send the payment to the following email address: Zelle Email: payments@tekkojuku.org PayPal: To pay via PayPal, click the link below to complete your payment: PayPal Link: https://www.paypal.com/ncp/payment/Y5NL674GQCAV2 Once your payment is complete, please return to this form to submit your registration form. Confirm Payment *To continue, confirm that your payment is complete. If not, please follow the payment instructions before submitting.SubmitPlease do not fill in this field.
