Nonprofit Organization Utsunomiya City International Association

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Application Form for Events and Courses

To take part in an event or a course, please fill out the form below, and press the confirmation button at the bottom.

※ Indicates required information.

※Event / Course Title
※Full Name
Furigana
※Age	[Ex]２０
※Membership	Member　 Non-member
※Postal Code	-
※Address	Please select: Hokkaido Aomori Iwate Miyagi Akita Yamagata Fukushima Ibaraki Tochigi Gunma Saitama Chiba Tokyo Kanagawa Yamanashi Nagano Niigata Toyama Ishikawa Fukui Gifu Shizuoka Aichi Mie Shiga Kyoto Osaka Hyogo Nara Wakayama Tottori Shimane Okayama Hiroshima Yamaguchi Tokushima Kagawa Ehime Kochi Fukuoka Saga Nagasaki Kumamoto Oita Miyazaki Kagoshima Okinawa
	Municipality
	District & House No.
	Name of apartment
※Phone	[Ex]123-456-7890
※E-mail	[Ex]mail@ucia.or.jp
Inquiries

Nonprofit Organization Utsunomiya City International Association

〒320-0026 5th floor, Utsunomiya Omotesando Square Bldg., 4-1-1, Baba-dori, Utsunomiya City
Tel ：028-616-1870 / Fax ：028-616-1871 / E-mail ：ucia@ucia.or.jp