Join Us - Membership Form

Join Us

Become a member by filling the form below.

Full Name *

Gender *

Male

Female

Date of Birth *

Email *

Address in Japan *

Address in Sri Lanka *

Phone Number *

Membership Type *

Membership only (5,000 Yen)

Membership + Insurance (10,000 Yen)

Occupation *

Student

Office worker

Businessman / Business owner

Family Dependent

Other