Member's Form

This is a contact form exclusively for members.
For online classroom application, local training application, other contact information, please contact us using the form below.

* For regular inquiries, please contact us from "CONTACT".

CONTACT

STEP.1
Application
contact

STEP.2
Auto reply
email

STEP.3
Staff
email

STEP.4
Attendance
on the day


Your nameRequired

 

Company name / organization name
(in the case of corporation / business / organization, etc.)

 

Contact phone numberRequired

 

E-mailRequired
※Please be sure to set the permission in advance in your security setting so you can receive email from "marie@jirikiseitai.jp" to avoid the confirmation email sent to junk mail.

 

Please select your requirementsRequired

※Please select a lesson subject from the above.

 

Please answer if you are applying for the online class. Have you complete the payment?

※Prior payment is required for joining the online class. Please be aware that if you don’t completed the payment before the class, you might not be able to join the class.

 

Please tell us how you found out about Jiriki seitai.

 

Others
(various contact information / inquiries)

 

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Member registration and various applications