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Membership Form

※indicates required fields

Types of Membership
※		 Corporate Membership
Individual Membership
Number of memberships
※		 Number of memberships：
（Annual contribution of 100,000 yen per Corporate Membership・Annual contribution of 10,000 yen per Individual Membership）
Your Name
※
Your Company Name
Department
Occupation/Position
Postcode
※		 （example：000-0000）
Address
※
Phone
※		 - -
FAX - -
Email
※

※Please re-enter your email address for confirmation
Please check one
※		 AJALT may publish the company name as a corporate member
AJALT may not publish the company name

Please check below.


I have read and agree to the "AJALT Handling of Personal Data" （*）

 

AJALT

2F Toranomon ES Bldg.
3-25-2 Toranomon Minato-ku,
Tokyo 105-0001, Japan

03-3459-9620 (Office hours 9:00 am - 5:00 pm Mon. - Fri.)
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