Membership Application Form

• E-mail Address

  mandatory

• Secondary E-mail Address

• Name

  mandatory

• Gender

  mandatory

  MaleFemaleOther

• Title

  mandatory

  Mr.Mrs.MissMs.Dr.Prof.Mx.

• Date of birth

  mandatory

• Nationality

  mandatory

• Name of spouse/partner

• Home address

• Home phone/Private mobile phone

• Occupation/Organization

• Job title

• Office address

• Office phone/Office mobile phone

• Billing address

  mandatory

  HomeOffice

• Mailing address/Monthly E-News to be sent to:

  mandatory

  E-mail AddressSecondary E-mail Address

• Membership Category

  mandatory

  Resident in JapanNon-resident in Japan

Initial donation Amount mandatory

Please select the donation amount for the category selected above

• Resident in Japan

  JPY 200,000JPY 400,000JPY 100,000 (applicants aged 45 years or less)

• Non-resident in Japan

  JPY 100,000JPY 300,000JPY 50,000 (applicants aged 45 years or less)

• If a family member or relative is a member of I-House, please provide their name and your relationship to them.

• Specialty

• Education

• Professional Experience, Associations and Accomplishments, etc.

• Reason for applying for membership, including any contributions you can make as a member and any expectations regarding the I-House and its activities

  mandatory

• Name of member who support your application (Primary)

  mandatory

• Name of member who support your application (Secondary)

  mandatory

• Kindly note that we may contact the recommenders in the unlikely event that the nominee violates membership bylaws or behaves in a manner unbecoming a member.

• Privacy Policy

  I hereby apply for membership in International House of Japan, and agree to endorse its aims and activities and to abide by its membership bylaws. Furthermore, I have read and understood the contents of its privacy policy.
  Agree

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