能美市国際交流協会入会届/Application form for NIEA membership
一人一人で別の申し込みを書いてください/Please fill in a separate form for each person
※ご記入いただいた個人情報は会員簿作成と協会からのご連絡のみに使わせていただきます/The personal information that you have provided will be used only for the purpose of registration and for contacts from the Association.
問い合わせ/Inquiry
niea.jimu@gmail.com ☎　0761-57-3751
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私は能美市国際交流協会に入会します（個人・家族・団体）/I hereby apply for the membership in Nomi International Exchange Association (personal membership/family membership/organization membership)

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お名前/Name *
お名前の読み方/Name reading in katakana
生年月日/Birthday
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MM
/
DD
/
YYYY
性別/Gender
 *
国/Country
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住所の郵便番号/Address zip code
 *
住所/Address
電話番号 /Phone number *
メール  /E-mail *
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