Registration Form for The 1st Annual Aikido-L European Seminar - 2000 November 11-12, 2000 at the Anton Geesink dojo in Utrecht, Netherlands Please type, and use a separate form for each attendee. Return to justin.mccarthy@sybase.com Last Name:__________________________ First Name: ________________________ Middle Initial: _____ Dojo: __________________________________ Rank: ____________________ Sex: F / M Mailing Address: House/Apt #: __________________________ Street: _______________________________________ City: ______________________ State/Province: _____________________ ZIP/Postal code: ____________ Country: ______________________________ E-mail address: __________________________ Telephone (opt): _______________ Attendance (please check one or both) [ ] 35 nlg - Saturday 11th November [ ] 25 nlg - Sunday 12th November I WILL / WILL NOT be joining the Friday Night Bowls Evening (please delete as required) If you will be accompanied on Friday by a non-registered guest, please let us know: I will have ___ guests on Friday Payment by Bank Transfer (preferred). Your local bank will be able to do this for you. You will need the following information: a/c no Postbank 8957100 Name Pauliina Lievonen Address Aardbeistraat 31 3552GD Utrecht The Netherlands Bank Address Postbank NV Amsterdam INGBNL 2A Payment by Cheque Please make cheques payable to Pauliina Lievonen and send to the following address: Pauliina Lievonen Aardbeistraat 31 3552GD Utrecht The Netherlands Payment is required in advance. Please note that there will be no refunds. Registration spots may be transferred with the consent of both parties registering and with notification to Signature: ________________________________________________ Date: ______________________