| Registration Form |
| NAME: | ______________________________________________________ |
| ADDRESS: | ___________________________________________________________________________ |
| TELEPHONE: | ____________________________________ |
| INSTRUCTOR: | ____________________________________ |
| DOJO:______________________________________ | STYLE: ___________________________________ |
| DURATION TRAINED: ________________________ | START DATE: ______________________________ |
| REGISTRATION: NEW or RENEWAL | DATE: _______________________ |
| TERM: | DOJO | 1 YEAR | $105.00 | ||||||
| G.S.T. is Included | STUDENT | 1 YEAR | $21.00 | ||||||
| 2 YEARS | $31.50 | ||||||||
| 3 YEARS | $42.00 |
| ADDITIONAL CREST(S) | __________________ $5.25 EA. TOTAL: ______________________ |
| STUDENT'S SIGNATURE: | __________________________________________________ |
| Please print and send Bank Draft or Certified Cheque to: |
| CMAC 5014 New St Unit 6, Burlington, Ontario, L7L 1V1, Canada |