MIHO MUSEUM Membership
Application Form
 
  1.I wish to enroll as a

Contributing Member (10,000 yen)
Sponsoring Member (50,000 yen)
Patron Member (300,000 yen)
  2.In addition to my membership fee, I am also sending a donation of ________yen.
  3.I am sending a total payment of ________ yen,

International Postal Money Order
Postal Giro Service
Bank Transfer

  Please give your full name and following information:
  Mr./Mrs./Miss/Ms.

Age:
  Address:
  Country:


 Postal Code:
  Phone:


 Fax: