Registration Form
Mark Pearcy 6th Dan Multiple Attack
Name
First Name
Last Name
Email
example@example.com
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Are you coming to Dinner on Saturday?(Pay at the venue).
Yes - just me
Yes plus 1
Yes plus 2
No thanks
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LUNCHES ***Do you wish us to order you a bento-box lunch (delivered to the dojo) on SATURDAY? Maximum prices are indicated below. Orders need to be received (and payment made) by Monday, 5th Aug if you want to take advantage of the offer. Please make your payment for lunches along with your course fee payment to the account listed on the next page, using your name as the payment reference.
No thanks
Teryaki Tofu $15.50
Teryaki Chicken 15.50
Bulgogi (Korean BBQ) 16.50
Grilled Salmon 17.50
Teryaki Tofu (Gluten Free) 15.50
Do you wish us to order you a bento-box lunch (delivered to the dojo) on SUNDAY. Same terms as for Saturday.
No thanks
Teryaki Tofu $15.50
Teryaki Chicken 15.50
Bulgogi (Korean BBQ) 16.50
Grilled Salmon 17.50
Teryaki Tofu (Gluten Free) 15.50
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GUESTS ONLY: If you are not an existing club member, you'll be asked to sign a disclaimer before being allowed to train. Please arrange your own personal injury insurance. Please supply below details of you age, club, organisation, grade and details of the amount of time you have been training. Please also let us know of any medical condition that might affect your own safety or that of others with whom you may be training.
Eg, Aged 34, Utopia Aikikai, 5th Kyu, 18 months training. No medical concerns
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Course Payment Options (Brisbane Aikikai Inc BSB: 064111 AC:10171456). Please use your name as the payment reference. Please select the applicable option.
I have paid - Full weekend $110
I have paid -Single Day: $60
I have paid Half Day: $40.00
I will pay on the day
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Name and Tel Number of your Emergency Contact:
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