Please fill in the basic information about yourself, and also the relevant fields depending on whether you want to have a trial stay at a dormitory, or just a visit.
��This mark shows required fields
�@ Request for info Request for trial stay Request for visit
��Name�� �FFamily name �@Given name
��ZIP Code�� �F example�F101-0011�@
��Address�� �F
��Telephone�� �F example�F1234-5678-0000
��Sex�� �F Male Female
��Date of Birth (YY/MM/DD) �F19 / /
��Name of college you want to attend �F
��Current school attended �F
��E-mail address �F we will send mail to this address
��Name of legal guardian �F
   
��If you are applying for a provisional dormitory room lease, a trial stay or a visit, please fill in the relevant information below.
Customers applying for a trial stay reservation are requested to complete the following information.
��Mobile phone �F example�F000-1234-5678
��Desired period of stay 2009/ / Evening check-in date
�@ 2009/ / Morning check-out date
��School attended (or taking test to attend) �F
Customers applying to visit a dormitory are requested to complete the following information.
��Mobile phone �F example�F000-1234-5678
��Desired visit date & time(YY/MM/DD) �F2009/ / / o'clock�iplease use the 24 hour clock�j
�@Relation of escort to resident Parents Father Mother Brother/sister other
��Dormitory requested to visit (choice 1)
�@Dormitory requested to visit (choice 2)
�@Dormitory requested to visit (choice 3)
�@Dormitory requested to visit (choice 4)



��Personal information submitted to us is handled according to protection of privacy laws, and will not be passed on to other companies or third parties. If you do not wish to receive further information from us that may be of interest to you, we respectfully request you to inform us of this.

Copyright (C) 2008 Tohjin Corporation. All Rights Reserved.