Registration Form for
                   The 2nd Annual Aikido-L Seminar - 1999

       November 6-7, 1999 at (or near) the Virginia Ki Society Dojo in 
                           Merrifield, Virginia

 (Please type or print, and use a separate form for each attendee)


 Last Name:______________  First Name: _______________  Middle Initial:  _____


 Dojo:  ___________________________  Rank: ______________  Sex:   (  F  /  M  )


 Mailing address:

 Street:  _________________________________________________ Apt #:  __________

 
 City:  _________________ State/Province:  ___________ ZIP/Postal code: ______


 Country: ______________________________


 E-mail address:  __________________________ Telephone (opt):  _______________


 Fee enclosed:  (please check one) 

   [  ]  - US$50 - Early registration (received prior to October 15, 1999)
   [  ]  - US$60 - Late registration (after October 15, 1999 or at the door)

 Please make payments payable to VIRGINIA KI SOCIETY, and mail to:

        VIRGINIA KI SOCIETY
        AIKIDO-L SEMINAR '99
        P.O. Box 2351
        Merrifield, VA  22116
        USA

 I understand that I undertake this seminar at my own risk and hereby release
 the Virginia Ki Society, and all others involved in holding this seminar,
 from liability should I injure myself.  
 (Parental signature required for participants under age 18).


 Signature:  ____________________________________ Date: ______________________


 Emergency Contact: ___________________________  Telephone:  _________________


 T-Shirt size (circle one):   NONE    S    M    L    XL   2XL    I8TOKYO

 (NOTE: T-shirt not included with registration, we're just trying to get
  a size-distribution, and desire estimate for ordering purposes)