IDRiM Member Registration Form

 

Please complete registration information

E-mail address:
 
Mr Ms Prof.
First name:
Family name:
Nationality:
Affiliation:
Research Area/
Research Interests:
Address
Street
(incl. bldg number):
City, State
(incl. ZIP code):
Country
(of your address)
Phone1: country code:   area code:   number:   ext.:
Phone2: country code:   area code:   number:   ext.:
Fax: country code:   area code:   number:   ext.:
URL
(of your Web page):
http://
Types of membership:
 

For more information on membership type and fees please go to: http://idrim.org/?page_id=37

or

  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