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  • Clinic Registration Form

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    Super Perez
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    Clinic Registration Form To be completed by country representative. Clinic fees: One clinic only: Two clinics: Name Ex. 1 2 3 4 5 6 7 8 9 10 Amount Enclosed: US$: John DOE US$40 US$60 Birth Date Month / DD / YYYY Jan. 1, 1975 Instructor / Trainee Instructor 1st Clinic X 2nd clinic.

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    Clinic Registration Form To be completed by country representative. Clinic fees: One clinic only: Two clinics: Name Ex. 1 2 3 4 5 6 7 8 9 10 Amount Enclosed: US$: John DOE US$40 US$60 Birth Date Month / DD / YYYY Jan. 1, 1975 Instructor / Trainee Instructor 1st Clinic X 2nd clinic.

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    81 views1 page

    Clinic Registration Form

    Uploaded by

    Super Perez
    Clinic Registration Form To be completed by country representative. Clinic fees: One clinic only: Two clinics: Name Ex. 1 2 3 4 5 6 7 8 9 10 Amount Enclosed: US$: John DOE US$40 US$60 Birth Date Month / DD / YYYY Jan. 1, 1975 Instructor / Trainee Instructor 1st Clinic X 2nd clinic.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
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    Clinic Registration Form

    To be completed by country representative Country: ______________________________ Clinic details: 1st Clinic 2nd Clinic Clinic fees: One clinic only: Two clinics: Name Ex. 1 2 3 4 5 6 7 8 9 10 Amount Enclosed: US$: John DOE

    November 8, 2012 November 9, 2012

    5:00pm-6:30pm 5:00pm-6:30pm

    Master Yutaka YAGUCHI Master Teruyuki OKAZAKI

    US$40 US$60 Birth Date Month/DD/YYYY Jan. 1, 1975 Instructor/ Trainee Instructor 1st Clinic X 2nd Clinic X

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