Application form

• The information in this application will be used only for registration and administrative purposes.
• Please pay the membership fee by bank transfer to the specified account at Japan Post or Yucho Bank. We will send the transfer details to the postal address you gave us.
• After we have confirmed your payment, we will send you your Membership ID number and your password for “My page” where you can view and edit/update your registration information at any time.
• We will send you various information, so please give us also your e-mail address.
• If you are a student member, please enclose your Student Certificate. You can use the form below. Please send the completed form by post to the Secretariat, or scan the document and send it to us by e-mail.
  Student Certificate
  Postal address:
  Membership Division, The Japan Society of Atmospheric Chemistry, Academy Center, Yamabukyo 358-5, Shinjuku-ku, 162-0801 Tokyo
  email: jpsac-post@as.bunken.co.jp　(FAX:03-3368-2822)

(*) Required fields

Name(*)

Type of membership(*)

Regular Student

Email address(*)

Gender(*)

Male Female

Postal address(*)

Affiliation Home

Affiliation (workplace)

Department (If you are a student member, please specify the name of your division and school year)

Supervisor (If you are a student member, please specify the name of your supervisor)

Supervisor's Email address

Address (work). Please start from the zip code.

Phone number (work)

Fax number (work)

Home address

Phone number (home)

Fax number (home)

Correspondence

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