Entry of Membership Information 1/2

Please fill in the blanks for the following items:
If you have no affiliation, fill your home contact information in business contact information.
* shows that this item is required.

Membership year*
Type of membership*
Type of membership

Every student is enrolled as a regular member.
Name*
Family name and given name

*A space is required between your family name and given name.
Affiliation
Name of university, institute or organization *
College, school or department
Position
Contact information: Business
Zip code *
* Hyphens are acceptable.
Address *
Phone number *
* Hyphens are acceptable.
Fax number
* Hyphens are acceptable.
Outside Japan
Email address *
Contact information: Home
Zip code *
* Hyphens are acceptable.
Address *
Phone number *
* Hyphens are acceptable.
Fax number
* Hyphens are acceptable.
Outside Japan
Email address
※ Please input it by normal-width. （Example）info-jomsa@jomsa.jp
Mailing address Preferred mailing address

Please select a payment method.

Payment method Charge my credit card Bank Transfer
Credit card information
 Card type
Other credit cards are not acceptable.		 Detailed information
Card number − − −
※ Please input it by normal-width.
Expiration date /
(mm/yy：As it appears on the card)
Cardholder name (As it appears on the card)
Invoice If you need invoice, please click [Invoice] below and print out the invoice form in the PDF format.
　[Invoice]
Receipt A Digital receipt will be sent by email. If you need a printed-out receipt by snail mail, please check below.
I need a printed receipt by mail.

If you select credit card payment, the annual membership fee from the subsequent fiscal years will be automatically charged to your credit card in every March.