APYC2012 Registration

Dr/Mr/Mrs/Ms : *

Family name as on passport: *

Given name(s) as on passport: *

Name which you prefer to be called: *

Contact address: *

Nationality: *

Phone: *

Email: *

Occupation: *

Fax:

Date of birth: *

I am : *

International Student : the cost is ¥ 40,000- JPY

a Local Student : the cost is ¥ 40,000- JPY

a Local Adult : the cost is ¥ 50,000- JPY

Emergency contact

Name: *

Phone Number: *

Visa:

Visa

yes, I need a visa

Please enquire whether you need a visa by consulting one of the following

the nearest Consulate-General of Japan
ID and Visa provisions for entry into Japan
your travel agent

Passport No.: *

Expiry date: *

Travel By :: *

Rail

Road

Ship

Air

Arrival Date: *

Arrival Time: *

Departure Date: *

Departure Time: *

Meals (Please Select):: *

Vegetarian

Non-vegetarian

Allergies / Food requirement:

Reasons for wanting to participate this APYC. Responses should be a minimum of 200 words.: *

Prior experience with the IofC network and/or its programs : : *

Yes (please specify)

If your answer is YES, please provide a reference person within the IofC network.

Name:

Email:

Phone:

About English

The main language of communication in the APYC will be English. Please give your considered and honest response to the following questions :

Is your spoken English :: *

Is your understanding of Written English :: *

Applicant’s Signature: *

Date: *

第18回のアジア太平洋青年会議（APYC）は、2012年8月22日から29日の会期で日本の東京及び富士吉田で開催されます。日本では1997年に続いて2回目の開催となります。