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C250
MEMBERSHIP and /or Book, or Dierctory Application Form
Registration Day
Month(2 Digits) Day(2 Digits) Year
Application of
Membership (5000 yen) History Book (1000 yen) Member directory (1000 yen)

Day of Bank transfer
I transferd to CUAAJ's bank account on Month(2 Digits) Day(2 Digits) Year.

Name
Name:First Last
Membership Number(If you have):

Home Information
Address:
Telephone:
email:

Busienss Information
Business:
Position:
Address：
Telephone:
email:

Relationship to Columbia
School attended:
Years attended:
Degree Obtained:

Director Listing
Please check the box if you do NOT prefer your information listed on the member directory.
Please check the box if you do NOT prefer your home address listed on the member directory.

Comments
Comments:

Fist name, last name, home address and home email is required to process.
If you have trouble on filling the form, email here.

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