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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
email 　info@iia21.jp
Business Hour　9:00～17:00
　　（12:00～13:00 Closed）
Except Sat. Sun. Nat. Holidays