JIIPA Membership Application Form

Application Type [Required]

Individual Corporate/Organization

Regular Member (Annual Fee: ¥10,000) Supporting Member (Annual Fee: ¥120,000)

Corporate Name (Official) [Required]

Representative Name [Required]

Zip Code [Required] Without hyphen

Prefecture [Required]

City/District [Required]

Address 1 (Town name and below) [Required]

Building Name/Room Number

Phone Number [Required] Without hyphen

FAX Number Without hyphen

Website Address

Industry/Business Content

Name [Required]

Department/Title [Required]

E-mail (Login ID) [Required]

Password [Required]

Phone Number [Required] Without hyphen

Bank Transfer (Details will be provided after acceptance) Request for Invoice

Year/Month/Day

May we send you guidance emails from our association?

Yes, I agree