- Fill out the following form, and then e-mail the image file, fax or mail to:
- E-mail: bunsikagaku-post(at)bunken.co.jp (Change "(at)" to "@")
- FAX: +81-3-5227-8631
- Address: Japan Society for Molecular Science
- 358-5 Yamabuki-cho, Shinjuku-ku, Tokyo 162-0801 JAPAN
Membership Application Form of Japan Society for Molecular Science
[Name]
First: Middle: Family:
[Mailing Address]
Phone: FAX: E-Mail:
[Membership Category (circle one)]
Regular: 4,000yen/year Student: 2,000yen/year
For Application of Student Membership
University or College:
[Payment method]
Please charge _____ Japanese yen on my credit card for my JSMolSci membership fee (for year _____)
VISA or MASTER Number (No other credit cards accepted):
Exp. Date:
Signature of Card Holder: |