About the Society

John Manjiro

Programs and Activities

Newsletter Index

Officers and Directors

Membership

Links

Site Map

Stats

Use this form to apply for attendance at or for more information on the 9th Japan-America Grassroots Summit, November 4-10, 1999 in Shizuoka, Japan.

1. Submit this form once for each person who will attend.
2. Please select first, second, and third choices of session to attend from the Session Preference lists. The summit trip includes attendance at only two sessions. (Click on "Select a Session" to see the list of sessions.) We will try to accommodate everyone, but we cannot guarantee you will get your choices.
3. Provide as much contact information as you can.
4. Click the "Submit Form" button to submit the registration form to the Manjiro Society. Information you submit will not be used for any other purpose.
5. Please send a $99.00 deposit to the Manjiro Society after you have submitted your application over the web, or print the application (after you have filled it out online) and mail it and the $99.00 deposit to the Manjiro Society.
6. All travel and Summit payments (minus the deposit) will be handled by IACE Travel (in Japanese or English). We will send you their form as soon as we have your application.
7. Please note that double occupancy (sharing a room with another traveller) costs each $100.00 less than otherwise.

Last Name (as on your passport)	First Name and Initial
Age Male Female
1st Session Preference (Click in box to see choices) Select a Session 1. The Culture Carried by Black Ships (Shimoda City) 2. Nature and Traditional Culture that we will hand down to the 21st Century (Numazu City) 3. An Ancient Trail Leads the way to a New Age of Tourism (Mishima City) 4. Japanese-American Cultural Exchange in the Izu Peninsula (Nirayama Town) 5. From Mount Fuji's Pure Water, Paper Treasures for You (Fuji City) 6. The Mt. Fuji Experience (Fujinomiya City) 7. Discover Cultural Differences between the U.S.A. and Japan (Shizuoka City) 8. To Build Energetic Community with Sports as the Central Factor -- Shimizu, the City of Soccer (Shimizu City) 9. Experiences of No. 1 Things in Japan, in the City with the Most Beautiful View of Mt. Fuji (Kanbara Town) 10. Spend Days of Wine & Roses in Shimada (Shimada City) 11. Maintaining Good Health and Eating Healthy Foods (Daito Town) 12. "YARAMAIKA" SPIRIT (Let's try!) (Hamamatsu City) 13. Survey of Automobile Culture in the 21st Century (Kosai City) 14. Postal Cultural Exchange (Shizuoka City, Gotenba City) 15. The Young Farmers of Today Supporting the Agriculture of Tomorrow (West area in Shizuoka Prefecture) 16. Relations for the Hearing Impaired (Shizuoka City, Numazu City) 17. Nurturing NPOs, Mount Fuji, Children, the Community (Shizuoka City, Hamamatsu City, sites around Mt. Fuji)
2nd Session Preference (Click in box to see choices) Select a Session 1. The Culture Carried by Black Ships (Shimoda City) 2. Nature and Traditional Culture that we will hand down to the 21st Century (Numazu City) 3. An Ancient Trail Leads the way to a New Age of Tourism (Mishima City) 4. Japanese-American Cultural Exchange in the Izu Peninsula (Nirayama Town) 5. From Mount Fuji's Pure Water, Paper Treasures for You (Fuji City) 6. The Mt. Fuji Experience (Fujinomiya City) 7. Discover Cultural Differences between the U.S.A. and Japan (Shizuoka City) 8. To Build Energetic Community with Sports as the Central Factor -- Shimizu, the City of Soccer (Shimizu City) 9. Experiences of No. 1 Things in Japan, in the City with the Most Beautiful View of Mt. Fuji (Kanbara Town) 10. Spend Days of Wine & Roses in Shimada (Shimada City) 11. Maintaining Good Health and Eating Healthy Foods (Daito Town) 12. "YARAMAIKA" SPIRIT (Let's try!) (Hamamatsu City) 13. Survey of Automobile Culture in the 21st Century (Kosai City) 14. Postal Cultural Exchange (Shizuoka City, Gotenba City) 15. The Young Farmers of Today Supporting the Agriculture of Tomorrow (West area in Shizuoka Prefecture) 16. Relations for the Hearing Impaired (Shizuoka City, Numazu City) 17. Nurturing NPOs, Mount Fuji, Children, the Community (Shizuoka City, Hamamatsu City, sites around Mt. Fuji)
3rd Session Preference (Click in box to see choices) Select a Session 1. The Culture Carried by Black Ships (Shimoda City) 2. Nature and Traditional Culture that we will hand down to the 21st Century (Numazu City) 3. An Ancient Trail Leads the way to a New Age of Tourism (Mishima City) 4. Japanese-American Cultural Exchange in the Izu Peninsula (Nirayama Town) 5. From Mount Fuji's Pure Water, Paper Treasures for You (Fuji City) 6. The Mt. Fuji Experience (Fujinomiya City) 7. Discover Cultural Differences between the U.S.A. and Japan (Shizuoka City) 8. To Build Energetic Community with Sports as the Central Factor -- Shimizu, the City of Soccer (Shimizu City) 9. Experiences of No. 1 Things in Japan, in the City with the Most Beautiful View of Mt. Fuji (Kanbara Town) 10. Spend Days of Wine & Roses in Shimada (Shimada City) 11. Maintaining Good Health and Eating Healthy Foods (Daito Town) 12. "YARAMAIKA" SPIRIT (Let's try!) (Hamamatsu City) 13. Survey of Automobile Culture in the 21st Century (Kosai City) 14. Postal Cultural Exchange (Shizuoka City, Gotenba City) 15. The Young Farmers of Today Supporting the Agriculture of Tomorrow (West area in Shizuoka Prefecture) 16. Relations for the Hearing Impaired (Shizuoka City, Numazu City) 17. Nurturing NPOs, Mount Fuji, Children, the Community (Shizuoka City, Hamamatsu City, sites around Mt. Fuji)
Indicate your interest in optional side trips to Yamagata and Atama & Kamakura
Home Address Home Phone Home FAX Home E-Mail	Office Address Office Phone Office FAX Office E-Mail