October 7-8, 2000 at the Boulder Aikikai dojo in
Boulder, Colorado

(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): _______________

[ ] - US$40 - Early registration (postmarked prior to October 1, 2000)
[ ] - US$50 - Late registration (postmarked later than October 1, 2000 or at the door)

Please note that there will be no refunds. Registration spots may be transferred with the
consent of both parties registering and with notification to Jun.

Please make payments payable to Jun Akiyama, and mail to:

Signature: ____________________________________ Date: __________________

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