「The Earth Summit at Konohana Family」Application Form

<Full name>*

<Nationality>*

<Age>*

<Gender>*

<Date of birth>*
/ /
mm/dd/yyyy

<E-mail>*

(confirmation)

<Address>*

<Phone Number>*
Please type using half-width digit.

<Occupation>

<Level of your Japanese fluency>

<Your Brief Profile>*

<Message to the Earth Summit>*
Please share your feelings/expectation.

<Style of Participation>*

If you wish to participate partially, please let us know if you need an accommodation.
If so, please indicate the night you need an accommodation.

<Date and time of arrival>*

<Transportation>*

<Date and time of departure>*

<Note>

 Please check in the box if the above information is correct and click the "Send" button.

※After you sent out the form, we will send you the confirmation message to the e-mail account that you input the form in two days. If you will not receive the confirmation message, we are sorry to trouble you, but please directly contact to info@npo-greengrass.org