Registration – Seishinkan Iaido

Personal Details

First Name^*

Last Name^*

Username^*

Profile Picture

Size Restrictions: Please make sure the image size is equal to or larger than 150 by 150 pixels.

Password^*

Confirm Password^*

Street Address^*

City^*

State/Prefecture/Region^*

Postcode^*

Country^*

Date of Birth^*

Phone Number^*

Email^*

Preferred Language^*

Dojo Information

Joining Date^*

Federation Member Number (if known)

Shibu^*

Current Dan^*

Date Grade Attained (if applicable)

Grading Examiner Qualification (if applicable)

Date Qualification Attained (if applicable)