Request for address modification

Please avoid using one-byte katakana characters, which might cause garbled characters and interfere with procedures.
Name
Previous workplace
New workplace
Affiliation *Be sure to enter your affiliation (department).
Address (workplace)	〒
TEL (workplace)
FAX (workplace)
Address (home)	〒
Address (home or workplace) for mail	home　mail
Membership number	(leave this field blank if unknown)
E-mail address
Consent to putting your e-mail address on the members list	Yes　No
Message