Application for Talks by A-bomb Legacy Successors/ Hibakusha Family Member Legacy Successors
We will check the availability of the venue in the museum after confirming your application. If you would like to a venue other than the museum, please enter your preferred one in No.14 section.
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Your Name  (the person filling in this form) *
Your Phone Number *
1. Name of Applicant *
2. Applicant is *
3. Address of Applicant (please include country name ) *
4. Phone Number of Applicant *
5. Email Address of Applicant *
6. Contact Person on the Day *
7. Mobile Phone Number of the Contact Person *
8. Email Address of the Contact Person
(If different from the applicant)
9. Number of Participants *
10. Age  (please check all that apply) *
Required
11. Preferred Date *
MM
/
DD
/
YYYY
12. Preferred Time *
13. Language *
14. Comments / Additional Information (if any)
Submit
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