Name:
_____________________________________
Organization or company name:
_____________________________________
Your title:
_____________________________________
Nationality:
_____________________________________
Mailing Address:
_____________________________________
_____________________________________
_____________________________________
Telephone/Facsimile Numbers:
_____________________________________
_____________________________________
E-mail address:
_____________________________________
Fields of interest:
_____________________________________
_____________________________________
_____________________________________
_____________________________________
Membership category applied for (annual dues):
_____ Regular individual member - 10,000 yen (or US$100)
_____ Member's spouse - 5,000 yen (or US$50)
_____ Sustaining member - 15,000 yen or more (or US$150 or more)
_____ Student member - 5,000 yen (or US$100)
_____ Institutional member - 20,000 yen (or US$200)
Enrollment fee of 1000 yen or US$10, plus Annual Dues of:
_____________________________________
Total:
_____________________________________
Payment by (mark one)
1. Cash 2. P.O. Transfer 3. Check
4. Postal Union Coupon 5. Bank Transfer
Membership Applications may be submitted in person, by mail, by
fax, or by email to:
The Committee on Membership
The Asiatic Society of Japan
No. 9 Kowa Building B1
1-8-10 Akasaka
Minato-ku, Tokyo 107-0052
Japan
Tel/FAX: (03)5549-4751
Email: asj@gol.com