Registration Form

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以下の項目を入力して[決定]ボタンを押してください。
*印の項目は必須入力項目です。

Name of Applicant or Group*	Name of Representative / Group
Age and birthday*	years old / birthday
Category Age*	1. Under 122. Under 183. Under 244. Over 25
Proposal Category*
Area for Proposal	*specify the name of city/town/village
Contact adress*
e-mail address*	（確認用）
Tel
Fax
Participation Fee (Relief Donation)*	Total Credit USD
Date of Transfer	Bank Account Mizuho Bank, Ltd. Jiyugaoka branch Bank Code：0001 Branch Code：0533 Swift Code：MHBKJPJT Account Number：2546122 Account Holder Name：Association for Children’s　Environment Transfer the payment to the indicated bank account Applicant will be responsible for transfer fee
Comment
Member(1) Name (In case of group)	the person is representative In case of more than 10 members, please send the full list of members to the office of sponsor by mail.
Member(1) Age and birthday
Member(2) Name
Member(2) Age and birthday
Member(3) Name
Member(3) Age and birthday
Member(4) Name
Member(4) Age and birthday
Member(5) Name
Member(5) Age and birthday
Member(6) Name
Member(6) Age and birthday
Member(7) Name
Member(7) Age and birthday
Member(8) Name
Member(8) Age and birthday
Member(9) Name
Member(9) Age and birthday
Member(10) Name
Member(10) Age and birthday


	Registration_form(for FAX).pdf

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