Registration Form If you wish to become a US Shorin Ryu Member please complete this form and mail a check for $65 made payable to E. Ferrara, 211 Sheridan Blvd Mineola, NY 11501

Name: 

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DOB: 

Year started karate: 

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Date of last promotion: 

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Date of Shodan promotion: 

Dojo where you acquired Shodan: