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Name:

Address:

City / State:

Postal Code:

Country:

Home Phone:

Mobile:

Email:

Emergency Contact:

Dojo

Rank

No. of years training

I am registering for:

Full Weekend - Regular Price - $175 CDN

Single Day - Saturday May 22, 2010 - $95 CDN

Single Day - Sunday May 23, 2010 - $95 CDN

Other Options

Choose Taikai T - shirt size. (Included with Registration Fee)

med

lg

x-lg

Yes

No

I’m coming the Taikai banquet Saturday night
(I will pay for own dinner at the time)

TAIKAI WAIVER

Once you have filled out the form please read the following waiver carefully. By entering the “confirmation code” in the below title box and pressing the submit button you agree to and accept the conditions within the waiver.

If you agree to these conditions please type the Black Bold “confirmation code” in the text box below and press submit. You will then be taken to the payment page. Thank you.