Membership Registration Form
Name *
(CAPITALIZE example : MOHD ALI BIN MOHD )
Your answer
Email *
(example : johncena@gmail.com)
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
State of Residence in Malaysia *
IC Number *
(example: 880625-04-2398)
Your answer
Graduating Year (tentative) *
Date of Arrival in Japan *
(example: DD-MM-YYYY, if you don't remember MM-YYYY)
Your answer
Prefecture of Residence in Japan *
Address in Japan
(For mailing purposes)
Your answer
Name of University/College *
(CAPITALIZE example: TOKYO UNIVERSITY)
Your answer
Course *
(CAPITALIZE example: ELECTRONICS ENGINEERING)
Your answer
Your Sponsor *
Preferable Types of Email from Us
Verification of Information *
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