Application to Join JSASS Input Form

Application Form for JSASS Membership

Items with * are necessary ones on application.

Japanese|English

Basic Information

Name in Full: *
Contact E-Mail: *	(Except for cellular phone's address)
Date of Birth(mm/dd/yyyy): *	/ /
Gender: *	Male Female
Member Type: *	Regular Member Student Member Supporting Member Please select Regular Member, if you have a full-time job or you are a student with a full-time job.
Reference's Name(who should be regular member):
Reference's Affiliation:
Reasons for Application: *

Home Information

Zip-Code: *
Address: *
Telephone Number: *
Fax Number:
E-Mail:

Office(School)Information

Name of Organization: *
Branch/ Faculty (Department/ School): *
Title:
Zip-Code: *
Address: *
Telephone Number: *	Extension Number:
Fax Number:
E-Mail: *

Student Member Information

Course: *
School Year : *	Grade
Expected Date of Graduation (mm/dd/yyyy): *	/ /
Adviser's Name:
Adviser's E-Mail:
Student Registration Certificate: *	Send a copy of your student ID Card by post, FAX, or e-mail(shomu@jsass.or.jp) to JSASS. The copy of ID Card is disposed properly after it is checked.

Education

Name of University:
Department:
Year and Month of Graduation(mm/yyyy):	/
Graduate School(Name of University):
Department:
Year and Month of Graduation (mm/yyyy):	/
Degree:
Year and Month Degree Attained (mm/yyyy):	/

Other

Preferred Mailing Address: *	Home Office If someone is in charge of delivery of the JSASS journals in your organization, the journals are sent to him/her together. For student members mails are sent to the home address.
Method of Dues Payment: *	Bank Transfer Credit Card Others
Payment Method: *	If you chose 'Others' in 'Type of Payments Membership Fee', please input how to pay in bellow.