New Student Pre-Registration

Name :______Address :______:______City, State, Zip :______Phone :______Pittsburgh Dojo 412-298-4486 E-mail :______• www.PittsburghBujinkan.com e-mail: [email protected] Emergency Contact Info: ______

Have you ever been convicted of a crime? If so, what for? Yes or No ______Have you ever been diagnosed with a mental disorder? If so, what? Yes or No Living the Budo Arts with Open Minds and Open Hearts ______Are you on prescription medication? Is so, what and what for? Yes or No ______

Togakure Ryu Ninpo Do you have a medical condition that would aff ect your training? Yes or No • Please Describe: ______Gyokko Ryu Kosshijutsu • College Student(Circle One): Yes or No Multiple Family Members Yes or No Kukishinden Ryu Happo Hiken- Age(s) :______Prior Martial Art Experience :______jutsu Ranking in Bujinkan (If Applicable) : Kyu______Dan______• Uniform Information: Height:______Weight(Approx):______Shoe Size:______Koto Ryu Koppojutsu Shirt Size:______• Shindenfudo Ryu Dakentaijutsu • Training Rates: Jo-Nin Level Chu-nin Level Genin Level Takagi Yoshin Ryu Jutaijutsu Monthly Committment Level $165.00 $125.00 $95.00 • Gikan Ryu Koppojutsu Required - PBTSD Yearly Membership (Due Jan 1st Every Year) - $95.00 • Gyokushin Ryu Offi ce Use Only • Date Started :______Kumogakure Ryu Ninjutsu Fee Rate $______Amount Paid $______69101 Lynn Way, Suite 205 Dojo Nickname :______Pittsburgh, PA 15208 Signed Waiver Date :______Jo-Nin Student Commitment Level

• Attend unlimited classes • Ranking fees up to Shodan included • Annual Dojo Membership included • Membership into our closed Facebook Community • Training weapons provided (wooden basic stuff – Hanbo, Bo, ) – dojo will source quality items and provide to student by rank 9th, 6th, and 3rd • Annual camp and camp t-shirt included (chair and camp gear is not) Pittsburgh Bujinkan Dojo • Includes attendance to all internally delivered seminars 412-298-4486 • Discount on seminars/training involving outside instructors (actual discount • www.PittsburghBujinkan.com levels based upon size of costs of speci c events, guest instructors) • Includes 3 books from required reading list by rank 9th, 6th, and 3rd (for ex- e-mail: [email protected] ample Facing Violence, Unarmed Fighting Techniques, History & Traditions of Ninjutsu) • Dojo work responsibility can be voluntarily waived (be clear if you are in or out for these responsibilities) • Heavy weight/Instructor weight Jonin Do-gi uniform Included • All Rank patches included Living the Budo Arts with • Dojo training t-shirt Included Open Minds and Open Hearts • PBTSD Training Manual and Student Notebook Included • Dojo Challenge Coin Included

Investment - Total Cost: $165/Month Togakure Ryu Ninpo Taijutsu • Chu-Nin Student Commitment Level Gyokko Ryu Kosshijutsu • • Attend unlimited classes Kukishinden Ryu Happo Hiken- • Membership into our closed Facebook Community • Includes attendance to 1 internal seminar per year jutsu • Mid weight Chunin Do-gi uniform included • • All Rank patches included Koto Ryu Koppojutsu • Student Notebook Included • 50% off : Shindenfudo Ryu Dakentaijutsu • Training manual (1 copy only) • • Dojo Challenge Coin Takagi Yoshin Ryu Jutaijutsu • Kyu Rank Fees • • Annual ninja camp and camp t-shirt Gikan Ryu Koppojutsu Investment - Total Cost $125/Month • Gyokushin Ryu Ninjutsu Genin Student Commitment Level • Kumogakure Ryu Ninjutsu • Attend unlimited classes • Membership into our closed Facebook Community • Student weight Gi included

69101 Lynn Way, Suite 205 Pittsburgh, PA 15208 Investment - Total Cost: $95/Month Add-Ons/ A La Cart

• Annual PBTSD Membership - $95 • Rank Fees – include any belt and patch changes -$75 per Kyu Rank • Student weight Genin Do-gi uniform - $30ea • Mid weight Chu-Nin Do-gi uniform - $60ea • Heavy weight/Instructor weight Ju-Nin Do-gi uniform - $145ea • OPTIONAL - Upkeep dues - $40 per month - this removes your requirement to help clean and maintain the dojo. You are still expected to clean up a er your- Pittsburgh Bujinkan Dojo self. 412-298-4486 • • Training Manual - $50ea www.PittsburghBujinkan.com • Student Notebook - $25ea e-mail: [email protected] • Dojo Challenge Coin - $20ea • Dojo training t-shirt - $20ea • Internal Seminars - Varies by subject ($60 - $150) • Branded clothing and bags -Varies • Training weapons – typically purchased from 3rd parties, when sourced by the dojo, they will be available at the best price we are able to off er. Living the Budo Arts with Open Minds and Open Hearts

Rank Fees • Kyu Levels - $95ea • Shodan - $150 Togakure Ryu Ninpo Taijutsu • Nidan - $250 • • Sandan - $350 Gyokko Ryu Kosshijutsu • Yondan - $450 • • Godan - $500 • Shidoshi License - $250 Kukishinden Ryu Happo Hiken- jutsu • Koto Ryu Koppojutsu • Shindenfudo Ryu Dakentaijutsu • Takagi Yoshin Ryu Jutaijutsu • Gikan Ryu Koppojutsu • Gyokushin Ryu Ninjutsu • Kumogakure Ryu Ninjutsu

69101 Lynn Way, Suite 205 Pittsburgh, PA 15208