Join Aiki Extensions

Please fill out the following form to apply for membership.

The items marked with an asterisk are essential.
The last two items, on rank and affiliation, will be kept confidential.
Please do not use ALL CAPS.
Non-english characters and other special characters my cause an error. If you have any problems call John at 360-881-0274 or email john@jmckenzie.com

First Name *
Last Name *
Password (no spaces) *	(letters and numbers only)
Occupation
Areas of Interest or Practice*
AE Activity Mode	Conventional aikido practice in unconventional settings Using aikido movements in off-the-mat applications Nonphysical applications of aiki principles AE Administrative support
AE Activity Title
AE Activity Description

Languages Spoken
Other Skills and Interests

Organization
Address *

City *
State/Region *
Zip/Postal Code *
Country *

Home Phone
Work Phone
Mobile Phone
Fax

Email *
Website URL

Rank in Aikido *
Aikido Affiliations

Objective as an AE Member
PAYMENT CHOICE	(must be paid by March 1 for the current year)
	I will pay my dues by mail
	I will pay my dues by through PayPal
I will pay this amount:	$ Member fee is $50 or whatever you can afford
Click to submit your membership form