IDRiM Member Registration Form

Please complete registration information

E-mail address:

First name:

Family name:

Title:

Dr.

Prof.

Gender:

Male Female Other

Nationality:

Affiliation:

Present position / designation:

Research Area/
Research Interests:

Address

Street
(incl. bldg number):

City, State
(incl. ZIP code):

Country
(of your address)

Phone number:

country code: area code:

number:

URL
(of your Web page):

Types of membership:

Regular member

Supporting member

Supporting organization

Reduced fee

Student

Associated organization membersr

Name any member(s) of IDRiM that you might know :

Write shortly your interest to join IDRiM including possible contribution in promoting IDRiM Society:

For more information on membership type and fees please go to: http://idrim.org/?page_id=47

Confirmation will be e-mailed to you automatically, and this page will be replaced by another page with the contents of this e-mail if you select the Register button (please click only once, this process may take up to 2 min.).
If you receive no e-mail with the confirmation, then please double-check (on the next page that appears after registering), if your e-mail address is correct.
Should the problem persist, then please send an e-mail to the address given at the bottom of this page.

Comments and suggestions about this form would be most welcome:
office@idrim.jp