Registration Email-Form
This is the email-form for "Kanto Regional Meeting 2013".
Fill out the form below and click [ CONFIRM ] button. Required fields are indicated with an asterisk
*
.
From the next confirmation window, you can send your registration email to us.
Soon a confirmation email will be sent to your email address automatically.
When we receive your application email, we will send you the reconfirmation by email or by fax.
Name
Furigana
Name
*
Gender
*
Male
Female
Job
*
1：Teacher
2：Student
3：General
Office /School
Address
*
Zip-code
（3 digits - 4 digits）
Prefecture
Select
Gunma
Ibaraki
Tochigi
Saitama
Chiba
Tokyo
Kanagawa
Yamanashi
Other
Email
*
（- ＠ -）
Phone
*
(Hyphens are optional.)
Facsimile
（Hyphens are optional.
）
SIG
*
Select
SIG A: Developmental disorders and/or LD
SIG B: Teaching in Junior High Schools
SIG C: Tend-to-be-Slow Learners
Not join
（"Not join" are selectable.）
Day(s) to Join
*
1: Jan 5 - Jan 6 2 days(3,000 yen)
2: Jan 5 only 1 day(1,500 yen)
3: Jan 6 only 1 day(1,500 yen)
4: Student: Jan 5 - Jan 6 2 days(1000 yen)
5: Student:Jan 5 only 1 day(500 yen)
6: Student:Jan 6 only 1 day(500 yen)
Accomodation
*
1： Yes (10,000 yen)
2： No
Message
