New enrollment form

  • All your personal information will be protected and handled with carefull attention.
  • Your information is entrusted to us for the purpose of providing information and respond to your requests, but to be used for any other purpose. More information, please visit our Privacy Notice.
  • The items marked with *, are mandatory. Please complete.
  • Please use Alphanumeric characters for numbers.
*Full nameFamilly nameGiven name
furiganaFamilly nameGiven name
Zip/Postal Code 100-1000
Province
city Kitakami Yokohama
numbers 3-24-555
building name tuhanbuild 4F
Phone number 1000-10-1000
FAX number 1000-10-1000
*e-mail adress
*E-mail address (for verification)
*password
*Password (confirm)