Membership Application

(Annual membership fee includes subscription of JMSSJ, Due date: March 31, each year)

Name Family: First:

Mailing Address Phone: FAX: E-Mail:

Membership Category (circle one) Regular: 8,500yen/year Student: 4,000yen/year Corporate: minimum 15,000yen/year

For Application of Student Membership University or College: Name of Supervisor:

Please charge ________ Japanese yen on my credit card for my MSSJ membership fee (for year ________) VISA, MASTER or UC Number: (No other credit cards accepted) Exp. Date: Signature of Card Holder: Date:

Mail or Fax This Form to: The Mass Spectrometry Society of Japan, Member Service c/o International Academic Printing Co., Ltd. 8-8 Takadanobaba 3-chome, Shinjuku-ku, Tokyo 169-0075, Japan Tel: +81-3-5389-6076 Fax: +81-3-3368-2822