Membership Application

Fill out the following form, and then e-mail the image file, fax or mail to:
E-mail: bunsikagaku-post(at) (Change “(at)” to “@”)
FAX: +81-3-5227-8631

Japan Society for Molecular Science
358-5 Yamabuki-cho, Shinjuku-ku, Tokyo 162-0801 JAPAN

Membership Application Form of Japan Society for Molecular Science

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: