JAPANESE

JSRAE Application Form for Admission
Do not use half size of Katakana character that might be gabled to fail to send message.
Family Name @@@@@First Name
Male Female
Birth Date
Year/Month/Date		 / /
Affiliation
Affiliation
Division or Unit
Zip Code
Address
Building
Telephone
FAX
E-mail
Home Address
Zip Code
Address
Telephone
FAX
Educational Background
Final School
If you are a graduate student fills in undergraduate school.If you graduated graduate school, please fill in both undergraduate and graduate school.
Major Department
Graduation Year Month
If you graduated a graduate school,
Graduation Year Month
Student Registration Certification
--- for student applicant ---
I certify here that the above described person is registered in the department of , and grade of our school.
Name of School
Name of Certifier
(Student member should get the certification of his/her academic supervisor and the like)
Expected Graduation Year Month
Select your affiliation category
Category
Type of Business
Subscription of monthly journal "Refrigeration" is free for a member.
Subscription of JSRAE transactions
Delivery Address
Remittance
Select remittance way from the next year
Admission Month *1 Year
Please fill in the amount of remittance
Admission Fee (\1,500)
Annual Fee (Individual \9,600 /Student \4,800) *2
JSRAE transaction (\8,400)
Total Amount of Money
*1From the month you are registered as a member and "Refrigeration" is delivered.
*2 Period for the annual fee is from July 1 to June 30.


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