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Japanese

Membership Application

Please use your ability and power for the international contribution.
We are awaiting for your participation.
Annual member's fee
Japanese individual   \2,000
Student/Foreigner    \1,000
Corp. member's fee   \10,000/unit

If you like to join IIA, please fill out the followings and press the button of "Submit".
The membership is paid accordingly.

Name(family name, first name)(Required):

e-mail:

Phone(Required):

Address1(Required):

Address2:

Nationality:

Sex
Male Female

Date of Birth:
YearMonthDate

Available language:

Committees you like to join (Multi-selection acceptable)
Gardena Leshan Medan Rosenheim Issi
Homestay Jpn language Interpret Cross Culture
Foreign Resident
Student Youth

Hobbies

Other comments

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Ichikawa Int'l Exchange Assoc. (IIA)市川市国際交流協会

〒272-0021
2nd Floor, Dai 1 Fuji Building, 2-1-7 Yawata, Ichikawa, Chiba, Japan
Phone  +81-(0)47-332-0100
FAX    +81-(0)47-332-0101
E-mail  info@iia21.jp
Business Hour 9:00~17:00
  (12:00~13:00 Closed)
Except Sat. Sun. Nat. Holidays