Membership Application

(Annual membership fee includes subscription of JMSSJ, Due date: March 31, each year)
Name
Family:
First:
Mailing Address

Phone:
FAX:
E-Mail:
Membership Category (circle one)
Regular: 8,500yen/year
Student: 1,000yen/year
Corporate: minimum 15,000yen/year
For Application of Student Membership
University or College:
Name of Supervisor:
Please charge ________ Japanese yen on my credit card for my MSSJ membership fee (for year ________)
VISA, MASTER or UC Number:
(No other credit cards accepted)
Exp. Date:
Signature of Card Holder:
Date:
Mail or Fax This Form to:
The Mass Spectrometry Society of Japan, Member Service
Academy Center 358-5, Yamabukicho,Shinjuku-ku, Tokyo 162-0801 JAPAN
Tel: +81-3-5389-6076 Fax: +81-3-3368-2822