Aikido of South Florida

Morihei Ueshiba

osensei

osensei2

Tai no henko

osensei and wife

Uchideshi Application

Aikido of South Florida
Uchideshi Application & Information

Name:
Address:
City:
State:
Zip:
Country:
Name of Dojo:
Instructor:
Rank of Instructor:

Age:
Date of Birth:
Home Phone :
Rank:
Aikido Exp:
Date of Arrival:
Date of Departure:
E-mail Address:

Why do you wish to enter the Uchideshi Program?

HOW DID YOU HEAR ABOUT OUR UCHIDESHI PROGRAM?

	Aikido Today Magazine	Other:
	Aiki News Magazine	Referred by:
	Yellow Pages

WHAT IS YOUR MARTIAL ARTS BACKGROUND?

	Aikido		Tae Kwon Do
	Karate Do		Kung-fu
	Iado		None
	Judo		Jujutsu
	Hapkido	Other:
	Kendo

HAVE YOU EVER BEEN TREATED FOR OR HAVE
CURENT PROBLEMS WITH AN OF THE FOLLOWING?

	Heart Problems		Migraines
	Drug Addiction		Back Problems
	HIV		Depression
	Stress Relief		Black-outs
	Asthma		Abnormal Blood Pressure
Other: