JIIPA Membership Application Form

Application Type *

Individual Corporate/Organization

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

Corporate Name (Official) *

Representative Name *

Zip Code *

Prefecture *

City/District *

Address 1 (Town name and below) *

Building Name/Room Number

Phone Number *

FAX Number

Website Address

Industry/Business Content

Name *

Department/Title *

E-mail (Login ID) *

Password *

Phone Number *

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