Name* First Last Phone*Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I'm interested in:*Choose all that apply.MovementSelf defenseEnergy HealingBeing around positive peopleStress reliefA more positive frame of mindGaining strengthGroup classesToningGroup classesPrivate lessonsPlease introduce yourself.*Age*Please enter a number from 0 to 108.Gender:* Male Female Do you smoke cigarettes? Yes No Criminal history?* Yes No Please explain:*Medical considerations:*Choose your preference:* Perfection. Excellence. Just get it done. I don't care. Choose the best fit:* I pretty much already know what I want to learn. I am open minded to new perspectives. This is a waste of time. "I pay attention to details..."* Always Most of the time. Rarely. This is a waste of time. Finally, please tell us how you heard about Akiyama Dojo!GoogleFacebookInstagramTik tokA friend told meI saw an advertisementOtherWhat search terms did you use? How did you find us?! CAPTCHA