Application Form (Supporting Member/Individual)

International Research Institute (IRI)

Application Form (Supporting Member/Individual)

International Research Institute (IRI)

Dear Board Chairman 　　　　　　　　　　　　　　　　　　　Date: 　　　　　　　　　　　　　
　

Name

Address of your home
　
Telephone
Facsimile
E-mail

　　　　　　　　　　　　　　　　　　　　　attach your name card or write down below

Name of work place
Managerial position

Address of your work place

Telephone
Fax
E-mail

Contact destination:　　Home or Work place

I accept your prospectus and apply for admission
as a Supporting Member (Individual) in order to join the activities.

Initial Fee　
5,000 yen

Year 2002 (2002/April/1~2003/March/31)
10,000 yen×　　unit＝　　,000 yen

Total
　　　,000 yen

Transfer ：Mizuho Bank, Ltd., Inage Branch, "IRI "　
　　　　 Account Number: 2525925