Application for Withdrawal or Membership on hold 退会/休会申請
<Withdrawal, Membership on hold, Re-Admission, Cancellation>
Any fees paid to the SIRC cannot be repaid or be reimbursable. Pursuant to Articles 13 and 14 of the Policy, the withdrawal, membership on hold or re-admission to the SIRC shall be conducted as follows.

一旦お支払い頂きました会費につきましては、ご返金できません。 会員会則 第13条(休会)並びに第14条(退会)に基づき、下記の通り、退会・休会及び、休会後の復会・退会後の再入会の対応をさせて頂きます。
Email address *
Acceptance of the terms of this policy ご利用規約の確認
Please acknowledge your acceptance of the terms of this policy by ticking the box below.
上記 <退会・休会・復会・再入会規約> にご了承いただければ、チェックボックスにチェックをお入れください。
Withdrawal or Membership on hold 退会/休会 *
Child(ren)'s name(s) / お子様のお名前 (If you want to register multiple children, please enter name separated by a comma. 複数いらっしゃる場合は、カンマ , で区切ってご記入ください) *
Your answer
Name of Parent or Guardian 保護者氏名(日本語名の方は「漢字」でご記入ください) *
Your answer
Year of Leaving/Year of membership on hold ※Multiple registration possible 退会希望年/休会希望年 (年をまたいで休会される方は2020年2021年両方にチェックを入れてください) *
<Withdrawal>Please check the month of leaving or month of membership break you wish to take. <Membership on hold >You can check multiple month(s) during which you wish to take break. <退会の方>退会開始月にチェックをお願い致します。 <休会の方>休会される全ての月にチェックをお願いします。 *
Reason for Withdrawal/Membership on hold 退会/休会理由 *
Your answer
Any inquiries お問い合わせ
Your answer
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy