Ozenji Eco Gurashi Kankyo-kan

Name of representative Required

Last name　

First name　

Postal code Required

〒

Residence address Required

Please enter your information accurately as the lottery results will be mailed to you

Phone number Required

- -

E-mail Required

Number of participants Required
(Chaperones excluded)

※Please fill the participant's name and age in the following fields according to the number of participants.

If you have any other questions,
please fill out here.

Group name/Individual name

Number of people Required

Number of classrooms

First Name Required

Last Name Required

Phone Required

Email Required

1st preferred date & time Required

Year　 Month　 Day　 Hour　 Minutes

2nd preferred date & time

Year　 Month　 Day　 Hour　 Minutes

3rd preferred date & time

Year　 Month　 Day　 Hour　 Minutes

If there are any other questions please fill out here.