Please PRINT and MAIL IN this form with your cheque or EMAIL to kataylor@rogers.com
Online payments can also be made to this email via Paypal (to kataylor@rogers.com) or preferably, by electronic bank transfer (EMT).

2019 June 28-30

Seidokai Hyo Ho Niten Ichiryu Seminar
https://seidokai.ca/niten-seminar.html

Registration Form

NAME:________________________________________________
ADDRESS:_____________________________________________
TOWN/CITY: __________________________________________
PROVINCE/STATE, COUNTRY: __________________________
POST/ZIP CODE:_______________________________________
PHONE:_______________________________________________



Early-Bird Special
 Pre Registration Fees
 At the door Fees
All Classes
 $195
 $225 $250
One day only

$125
Friday only

$50

FEES SENT WITH FORM CDN$______  
Fees don't include travel/room/food.

PLEASE READ THE FOLLOWING CAREFULLY

I, the undersigned applicant to the Niten Ichiryu Seminar understand that I am applying for instruction in Niten Ichiryu, an activity that involves physical activity. I further understand that the CKF, the Sei Do Kai and associated persons carry no insurance against injury to any of the participants in the seminar.

I hereby acknowledge that I am assuming the risk and responsibility for any and all injuries that I may suffer, caused by me or caused by third parties to me arising out of the practice of Niten Ichiryu, or during the use of any of the facilities available. I further acknowledge that I am responsible for providing my own personal health, medical, dental and accident insurance coverage. I hereby release the Sei Do Kai and all of its associated persons from liability for any injury or loss suffered by myself.

DATE_______ SIGNATURE ______________________________

PARENT/GUARDIAN (under 18)___________________________


Please mail this form, cheques payable to: Sei Do Kai
E/Mail to: Kim Taylor kataylor@rogers.com at 44 Inkerman Street, Guelph Ontario Canada N1H 3C5