The Manjiro Society - 9th Summit Homestay

9th Summit Homestay Application Form

Use this form to apply for homestay while attending the 9th Japan-America Grassroots Summit, November 4-10, 1999 in Shizuoka, Japan.

Submit this form once for each person who wishes homestay.
We will try to accommodate your preferences but cannot guarantee a perfect match with a homestay family.
Click the "Submit Form" button to submit the homestay application form to the Manjiro Society. Information you submit will not be used for any other purpose.

Last Name (as on your passport)
First Name and Initial

Birthdate
Age
Male Female

Address

Phone

FAX

E-Mail

Occupation

Hobbies and Interests

Smoking
Pets

Allergies

Foods you can't eat or won't eat

Special Needs

Check any other Japan-America Summits you have attended.
Tokyo 1991 Boston 1992 Nagoya 1993 Virginia 1994
Kagoshima 1995 Colorado 1996 Yamagata 1997 Atlanta 1998

Why did you decide to participate in this summit?

What do you expect to learn in the Exchange session?

Any comments or messages to your hosts?

Comments on the Society's programs should be sent to the Executive Director.
Comments on the website should be sent to the Webmaster.
Page last updated Aug 15, 1999. Copyright 1998-2002, The Manjiro Society.