Register For The Samurai Game

Registration Form

INDICATE BY CHECKING FOR WHICH SEMINAR/TRAINING ARE YOU REGISTERING?

Required:( )
Date: Location:

First applicant:

Name
Address
Address
City	State	Zip
Phone -Home	()
Phone -Office	()
Fax	()
Email

Optional: (Second applicant)

Name
Address
Address
City	State	Zip
Phone -Home	()
Phone -Office	()
Fax	()
Email

Group/Corporate Tuitions and Programs are available.

REGISTER YOUR COMPANY, ORGANIZATION, CHURCH, STAFF, FACULTY OR TEAM?
Yes/No

Name of Organization
Address: line-a
Address: line-b
City	State/Prov Zip
Country
Contact Person	Their Position

Are you paying by VISA , MasterCard, Discover, or Check
Amount to bill card = $(US)
Cardholder's Name as appearing on Card
Card# (Fax Only) < Print & Fax Only-See Below
Exp Date xx/xx < Print & Fax Only-See Below

Signature of Card holder (Fax Only) __________________________________

	Make Check/VISA/MasterCard To: Allied·Ronin™
	Mail payment & registration to P.O. Box 931 Petaluma, CA 94953
	FAX payment & registration to 707-769-8544
	Phone 707-769-0328

Submit Form: Transmit

Print and Fax : Do Not Transmit

Static Form
E-mail: info@AlliedRonin.com