Membership Application Form


To: President of the Health and Welfare Statistics Association


We/I hereby would like to apply the Membership System wiith the
understanding of the activities of the Association and the Membership
System, together with the payment of the membership charge
(for one year) of 130,000 yen ( from abroad, 160,000yen).

Date________Month________Year__________
Name of Organization/
Company/Individual



Your Address



Name of Representative


____________________________________________________________

Seal or Signature
 Name/in charge of this application
 Telephone Number
FAX 
Address to which
our publications to be sent


 
Payment of the membership charge in Japan:
Please send the membership charge of 130,000yen through
the bank or the Japan Post's Postal Giro Service.
Payment of the membership charge from abroad:
Please send the membership charge of 160,000yen through
the bank, in Japanese Yen.
Payment through bank: You are requested to afford the bank's
charge for sending money.
Dissemination and Program Division
Health and Welfare Statistics Association
5-13-14, Roppongi, Minato-ku, Tokyo
Tel.: 03-3586-3361, from overseas: 81-3-3586-3361
Homepage: http://www.hws-kyokai.or.jp/



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