First Name: *
Last Name: *
Email: *
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City:
State: —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
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Birthdate: *
Favorite Location: * Miami
Phone: *
Are you male or female?
Identify MaleIdentify FemalePrefer not to answer
When do you usually visit Samurai? (check all that apply)
LunchDinnerHappy HourTake-out or DeliveryCatering
How often do you visit Samurai?
—Please choose an option—Once a MonthOnce Every 2-3 MonthsOnce Every 3-6 MonthsOnce Every 6-12 MonthsEvery Year For Your BirthdayRarely/Never
What are your favorite types of dishes on our menu?
ChickenLobsterScallopsShrimpSalmonSteakSushiTunaVegetarian
Which alcoholic beverages do you enjoy the most at Samurai?
WineSakeSpecialty CocktailsBeerI do not drink alcohol at Samurai
When do you enjoy dining at Samurai?
Special OccasionsFamily DinnerDinner with FriendsDate NightHappy HourBusinessOther
Celebrate the child in your life! Enroll them into our exclusive Samurai Kabuki Kids® program, just for kids ages 12 and younger. Members receive a special email certificate for their birthday that entitles them to a free souvenir mug of their choice with the purchase of any Kabuki Kids® meal.
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