Application Form for Membership

Please read our privacy policy and understand that the personal information included in your inquiry will be handled with care in accordance with this policy.

E-mail address for contact (mandatory)

Category of contact e-mail address
HomeOffice

Back-up e-mail address

Category of back-up e-mail address
HomeOfficeNot to register

Last name (mandatory)

First name (mandatory)

Middle name

Last name (Japanese)

First name (Japanese)

Gender (mandatory)
MaleFemaleOther

Title (mandatory)
Mr.Mrs.MissMs.Dr.Prof.Mx.

Date of birth (MM/DD/YYYY) (mandatory)

Nationality (mandatory)

Name of spouse/partner (Last Name, First Name, Middle Name)

Contact information

Home address

Home phone

Private mobile phone

Affiliation
　

Job title

Office address
　

Office phone

Office mobile phone

Billing address (mandatory)
HomeOffice

Mailing address (mandatory)
HomeOffice

Monthly E-News to be sent to: (mandatory)
HomeOffice

Membership Category (mandatory)
Resident in JapanNon-resident in Japan

Initial donation Amount (Please select the donation amount for the category selected above)

Resident in Japan
JPY200,000JPY400,000JPY100,000 (applicants aged 45 years or less)

Non-resident in Japan
JPY100,000JPY300,000JPY50,000 (applicants aged 45 years or less)

Name if one of your family/relatives is a member of I-House and relationship to the applicant

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.

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 .

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