Sogetsu LA Membership Registration
Select the Membership Year
*
Please Select
2026 - 2027
Name
*
First Name
Flower Name
Last Name
Email
*
example@example.com
Instructor Name
*
Amiya Sensei
Arao Sensei
Ariga Sensei
Furuya Sensei
GuneWardena Sensei
Laske Sensei
Lowitz Sensei
Kitajima Sensei
Kujiraoka Sensei
McDonough Sensei
Miyahara Sensei
Okada Sensei
Takeichi Sensei
Uemura Sensei
Zaima Sensei
If NOT listed, please comment in the notes section below.
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Diploma/Rank
*
Please Select
1st Certificate/４級修業証
2nd Certificate/３級修業証
3rd Certificate/２級修業証
4th Certificate/１級修業証
Teacher's Diploma 4th Grade/４級師範証
Teacher's Diploma 3rd Grade/３級師範証
Teacher's Diploma 2nd Grade Sanyo/２級師範証（参与）
Teacher's Diploma 2nd Grade Jonin Sanyo/２級師範証（常任参与）
Teacher's Diploma 1st Grade Somu/１級師範証（総務）
Teacher's Diploma 1st Grade Jonin Somu/１級師範証（常任総務）
Komon/顧問
Riji/理事
N/A
Headquarter No. (7-digit # - if you do not know write "none")
*
Are you an STA (Sogetsu Teachers Association) member?
*
Yes
No
What would like to pay?
*
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( X )
1 Year Membership
$
50.00
Would you like to purchase a Name Badge ($20)
$
20.00
Credit Card Details (Note: Please input your ZIP code in the "12345" field)
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
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