Membership registration　：　日本顕微鏡歯科学会

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Membership registration

Name *Required
Postal Code *Required	(Example: 200-0000)
Address *Required
Telephone *Required	(Example: 11-1234-5678)
FAX *Required	(If none, please fill in "none")
Workplace (name of clinic, etc.) *Required
Workplace postal code *Required
Work Address *Required
Workplace TEL *Required
Workplace FAX *Required	(If none, please fill in "none")
Mailing address for journals, etc.	Home Workplace
E-mail address *Required	Please fill in your computer address. Mobile email address is restricted.
E-mail address (for confirmation) *Required
Experience in using dental stereo microscopes	Yes No
Microscope models you have used
Membership fee category *Required	Regular member (admission fee: 5,000 yen + annual membership fee: 13,000 yen) Associate member (admission fee 5,000 yen + annual membership fee 5,000 yen) Supporting member (admission fee: 5,000 yen + annual membership fee: 30,000 yen)
Date of transfer of membership fee *Required	(Example: Jan. 23, 2009)
Other