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    [Reading about Japan at I-House Library]
    "Craig Mod--The Walk and Talk: Koya Bound and Walk Design"

    Date: Thursday, November 29, 2018, 7:00 pm
    Venue: Kabayama-Matsumoto Room, International House of Japan
    Speaker: Craig Mod (Writer / Photographer)
    Language: English (without interpretation)
    Admission: IHJ Members & Library Members: free; Non-members: 1,500 yen (reservation required)

    *All seats are now filled, but you can be entered on a waitlist in case of cancellations.

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    The Library, The International House of Japan
    5-11-16 Roppongi, Minato-ku, Tokyo 106-0032
    TEL: 03-3470-3213 (Mon.-Sat., 9:00 am-6:00 pm)
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