Seminar Registration Form 2026 October SeminarFull Name *Email Address *Phone Number *AddressPreferred 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:Please select your registration option.SelectMember – Friday – $30Member – Saturday – $75Member – Full Weekend – $90Non-Member – Friday – $40Non-Member – Saturday – $100Non-Member – Full Weekend – $120Payment:Please use one of the following methods to send the total amount for your order. Our preferred payment methods are:Total Amount$ 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/BKHHAP9KUZRQU 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.
