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    Application Form For The ASNOS Membership: Miyajima-T@inouye-Eye - Or.jp

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    bonny_07_fk_unsri9248
    This document contains an application form for membership in the ASNOS organization. Applicants are asked to provide their contact information, including name, address, institution, email, and fax. The membership fee is 4,000 Japanese yen and is valid for two years. Payment should be made via bank transfer to the specified Mitsubishi Tokyo UFJ Bank account. Contact information is also provided for the ASNOS office.

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    Application Form For The ASNOS Membership: Miyajima-T@inouye-Eye - Or.jp

    Uploaded by

    bonny_07_fk_unsri9248
    26 views1 page
    This document contains an application form for membership in the ASNOS organization. Applicants are asked to provide their contact information, including name, address, institution, email, and fax. The membership fee is 4,000 Japanese yen and is valid for two years. Payment should be made via bank transfer to the specified Mitsubishi Tokyo UFJ Bank account. Contact information is also provided for the ASNOS office.

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    This document contains an application form for membership in the ASNOS organization. Applicants are asked to provide their contact information, including name, address, institution, email, and fax. The membership fee is 4,000 Japanese yen and is valid for two years. Payment should be made via bank transfer to the specified Mitsubishi Tokyo UFJ Bank account. Contact information is also provided for the ASNOS office.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    26 views1 page

    Application Form For The ASNOS Membership: Miyajima-T@inouye-Eye - Or.jp

    Uploaded by

    bonny_07_fk_unsri9248
    This document contains an application form for membership in the ASNOS organization. Applicants are asked to provide their contact information, including name, address, institution, email, and fax. The membership fee is 4,000 Japanese yen and is valid for two years. Payment should be made via bank transfer to the specified Mitsubishi Tokyo UFJ Bank account. Contact information is also provided for the ASNOS office.

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    Application form for the ASNOS membership

    Please fill in the information required below and send it to ASNOS office by
    e-mail or fax. Please type clearly.

    □ I would like to renew my membership.


    □ I would like to make a new application.

    Your name

    Address

    Institution

    E-mail

    Fax

    The membership fee is \4,000 (JPY) and is valid for two years.

    Please pay the fee by bank transfer to the account below.

    Mitsubishi Tokyo UFJ Bank, Sagamihara Branch


    Branch Number :259
    Account Name: ANOS Wakakura Masato
    Account Number :1521052

    ASNOS office:
    Address c/o Inouye Eye Hospital
    4-3 Kanda Surugadai, Chiyoda-ku, Tokyo
    101-0062 Japan
    Telephone +81-3-3295-0911
    Fax +81-3-3295-0917
    E-mail miyajima-t@inouye-eye.or.jp

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