Hanshi Jerry Piddington's
2005 AKANA TRAINING LOG
Seminars, Classes, & Events Endorsed by AKANA

 

 

Please type, print, and send this form, along with the AKANA promotion application to AKANA Headquarters/PO Box 922/China Grove, NC 28023.
Name of Applicant:

Name of Dojo:

 

 Rank of Applicant

Instructor of Applicant:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

 
Seminar/Event/Class: Promoter/Phone:
Instructor(s):
 Date of Event:
 Credit Hrs:
Comments:

Credit hours should match the number of hours trained in the seminar.

If you have any comments or questions:
Call:  1-800-560-KICK
Email:   info@sidekickkarate.com