Member information registration

Please fill in the required information in the form below.
Please use your e-mail address as the login ID.

NameRequired	Example: Taro Yamada
Name againRequired	Example: Taro Yamada
Email AddressRequired	Example) info@example.com
Email address confirmationRequired
PasswordRequired	* 8 to 16 characters
Password confirmationRequired
Gender	Male Female
Date of birth	Year Moon Day Example) January 01, 1970
Phone numberRequired	- - Example) 00-0000-0000
Zip codeRequired	- Example) 0000000
PrefectureRequired
MunicipalitiesRequired	Example) Shibuya Ward
Enter the rest of Address	Example) 1-1-1 ○○ Town
Phone number (company)	- - Example) 00-0000-0000
Zip code (company)	- Example) 000-0000
Prefecture (company)
Municipality (company)	Example) 1-1-1 ○○ Town, Shibuya-ku
cell phone number	- - Example) 000-0000-0000
Mobile email address	Example) info@example.com
Fax number	- - Example) 00-0000-0000

Membership agreement and handling of personal information

I agree to the above membership agreement and handling of personal information