JCCIM

Membership Type*

Organisation Name*

Organisation Name (in Japanese) *

Address

Street*

Suburb *

State *

Post Code*

Postal Address (if different from above)

Street

Suburb

State

Post Code

Phone*

Website

Establishment Year (in VIC/TAS/SA/NSW) *

Capital Fund

Category of Business*

Sub Category of Manufacturing

Organisation Form*

Representative

Last Name*

First Name*

Last Name (Japanese)

First Name (Japanese)

Job Title*

Job Title (Japanese)

Email*

Number of members to be registered (Ordinary membership only)*

I hereby apply to become a member of the Japanese Chamber of Commerce & Industry, Melbourne Inc. (JCCIM). If accepted to be a member of the JCCIM, I agree to be bound by the Constitution, Rules and By-Laws made by the JCCIM.

I hereby state that all information supplied is true and correct. I am aware that any omission or false declaration in this application may lead to JCCIM declaring my membership denied or annulled.

Declaration by Applicant*

Membership Application