Members

JLS Membership Application

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1.Primary contact information

Salutation
First Name
MI
Last Name
Organization name
Depertment/Division name
Title
Address1
Address2
Address3
City
Country
Postal Code
Address Type
Phone
Phone Type
Email
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2.Home Address(If the primary address is not home address)

Home Address1
Home Address2
Home Address3
City
Postal Code

3.Supplemental Data

Date of Birth (mm/dd/yyyy)
Gender
I am currently a student
Highest Degree Obtained
Graduation Date

※ Please send after confirming that all the required items are filled in.

公益社団法人 日本地すべり学会 The Japan Landslide Society
Shimbashi Kato Bldg., 5-26-8, Shimbashi, Minato-ku, Tokyo 105-0004 Japan
Phone : +81-3-3432-1878 Fax : +81-3-5408-5250