VIP Registration Form

Name *

Date of Birth

Email *

Phone

Address

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

1. Did our Sushi exceed your expectations?

• Yes
• No

2. Did the showmanship of our hibachi chef exceed your expectations?

• Yes
• No

3) Was your food prepared and cooked the way you ordered it?

• Yes
• No

4) Was your table clean along with the silverware, dishes and condiments?

• Yes
• No

5) How would you rate the quality and freshness of the dinner you received? OutstandingAbove AverageAverageBelow Average

6) Is our current menu selection to your liking? OutstandingAbove AverageAverageBelow Average

Comments *

Message

Send Message