Hitto Kigan Ceremony Application Form (#76)

ご祈祷申し込み書

Gokitō Request Form

Please fill out the following form so that we may schedule your ceremony.
You will receive correspondence from Rev. Izumi Hasegawa, arranging the details of the event. Please respond to all emails from her.
Once the details are agreed upon this order will be set to fulfilled. Thank you.

※ご記入いただいた個人情報は、法律で定められた場合を除き、当神社のご祈祷・運営管理の目的にのみ利用させていただきます。

※Information submitted is used only for the Gokitō ceremony and Shrine administration. It is never sold or shared.

Details of the Person Requesting the Gokitō Ceremony

First Name

Last Name

Email Address

Phone Number

Ceremony Details

Information About the Film Production or Business Receiving the Gokitō Ceremony.

Production Company / Studio Name

Pronunciation of the Name (Please write in Japanese Katakana, if possible)

Film / Project Title (if available for disclosure)

Production Location(s) (if available for disclosure)

Production Start Date (MM/DD/YYYY)

Number of Cast and Crew Members

Additional Information About the Production (if any)

Please explain the reason for your ceremony request.

Included Items

This Gokitō ceremony includes the following Items:

One “Kin-Kitsune” (Good Fortune) Omamori
A Naorai Package

Additional Omamori

To request extra “Kin-Kitsune” Omamori, please request them here.

Scheduling Information

Please select three possible dates and times when you would be available for the ceremony. All times should be provided in Pacific Time.
If Rev. Izumi Hasegawa is unavailable on all three dates, she will contact you by email to arrange another date and time.

Option 1: Preferred Date and Time

Option 2: Preferred Date and Time

Option 3: Preferred Date and Time

Additional Information for Scheduling

Address and Attendees

Please provide the ceremony location and the expected number of people attending, including yourself.
For online ceremonies, we also require the full address from which you will be joining the ceremony. This information is important for the ceremony arrangements, even if the ceremony takes place remotely.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Number of Attendees

Please list the names of any cast, crew members, or other guests who will be attending the ceremony below.
Their names may be read aloud during the ceremony.
If you have more than ten additional attendees, please list their names in the text field below.

Additional Name 1

Relationship

Additional Name 2

Relationship

Additional Name 3

Relationship

Additional Name 4

Relationship

Additional Name 5

Relationship

Additional Name 6

Relationship

Additional Name 7

Relationship

Additional Name 8

Relationship

Additional Name 9

Relationship

Additional Name 10

Relationship

Please share any additional information or questions you may have about the ceremony.

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ご祈祷申し込み書Gokitō Request Form

Details of the Person Requesting the Gokitō Ceremony

Ceremony Details

Included Items

Scheduling Information

Address and Attendees

Event release Subscription

ご祈祷申し込み書

Gokitō Request Form