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WINTER COURSE 2009 REGISTRATION FORM   (please complete in BLOCK CAPITALS)

NAME   …….………………………..………………M/SHIP NO ………………... EXPIRY ….………

ADULT*/CHILD* under 16 years   (*delete as appropriate)

GRADE……………………………INSTRUCTOR…………………………………..…………………….

ASSOCIATION……………………………………………….CLUB……………….………………..……

ADDRESS …………………………………………………………………..……….……………..……….

………………………………………………………………………………..………………..…………….

TELEPHONE No ….……………………………E-MAIL……………….………………………………...

Please tick if you are going for Dan Grading

q 1^st Dan          q 2^ndDan          q 3^rd Dan          q 4^th Dan

I enclose a cheque / Postal Order payable to Mrs E. Labiri for £ ……………………

SIGNATURE  ……..………………..…………………      DATE…………………..………………….….

Complete and send the attached form to the address below as soon as possible to guarantee a place.

FLAT 2 SPA VIEW, LEIGHAM CLOSE, LONDON SW 16, 2LA, UK