Grandmaster Jerry Piddington's
2010 AKANA TRAINING LOG
Seminars, Classes, & Events Endorsed by AKANA

 

 

Please print and mail application and current photo along with check or money order:
AKANA / P.O. Box 571 / Denver, North Carolina  28037

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.

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 For more information about AKANA
Call:  1-704-579-7034