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Please complete this application form in its entirety in English only.
Please input all required fields (*) to proceed to the next page. |
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Membership type: * |
Please choose a membership type |
More information about membership types here. |
Category * |
Please choose a category |
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Category: * |
Please choose a category |
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Have you been a Tokyo American Club Member before? |
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Membership no: |
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Resignation date: |
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Click year to edit |
Senior/emeritus membership transfer: parent's name: |
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Senior/emeritus membership transfer: membership no: |
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Personal Information |
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First name: * |
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Middle name: |
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Last name: * |
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Gender: * |
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Home address in Japan |
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Address Line 1: * |
Please input data to proceed |
Ex. Homat House #105 |
Address Line 2: * |
Please input data to proceed |
2-1-2 Azabudai |
City (Ward): |
Invalid Input |
Minato-ku |
Prefecture: * |
Please input data to proceed |
Tokyo |
Postal/Zip: * |
Please input data to proceed
Format should be: XXX-XXXX |
106-8848 |
Home tel: |
Please include phone number with hyphens. |
03-4588-0687 |
Cell: * |
Please include phone number with hyphens. |
03-4588-0687 |
Home fax: |
Please include fax number with hyphens. |
03-4588-0687 |
Home e-mail: * |
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Nationality: * |
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Date of birth: * |
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Click year to edit |
English ability: * |
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Years spent in the United States: * |
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Years spent in other English-speaking countries: * |
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Education |
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Highest Education Completed |
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Name of school: * |
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School location: * |
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Graduation year: * |
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Degree: * |
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Couple Membership |
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Family Membership |
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Please supply the information below only if you are applying for Couple/Family membership. |
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Spouse first name: * |
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Spouse middle name: |
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Spouse last name: * |
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Spouse gender: * |
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Spouse nationality: * |
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Spouse date of birth: * |
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Spouse e-mail: * |
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Spouse cell no.: * |
Please include phone number with hyphens. |
03-4588-0687 |
Do you have children? |
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Child first name: |
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Child middle name: |
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Child last name: |
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Gender: * |
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Child date of birth: |
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Child nationality: |
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Do you have another child? |
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Child first name: |
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Child middle name: |
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Child last name: |
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Gender: * |
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Child date of birth: |
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Child nationality: |
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Do you have another child? |
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Child first name: |
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Child middle name: |
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Child last name: |
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Gender: * |
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Child date of birth: |
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Child nationality: |
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Do you have another child? |
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Child first name: |
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Child middle name: |
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Child last name: |
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Gender: * |
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Child date of birth: |
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Child nationality: |
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Do you have another child? |
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Child first name: |
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Child middle name: |
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Child last name: |
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Child date of birth: |
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Gender: * |
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Child nationality: |
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Current Employment Information |
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Name of current company: * |
Please input data to proceed |
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Position: * |
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Type of business: * |
Please input data to proceed |
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Please specify business type: |
Invalid Input |
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Business address in Japan |
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Address Line 1: * |
Please input data to proceed |
Tokyo American Club Building 3F |
Address Line 2: |
Invalid Input |
1-2-1 Azabudai |
City (Ward): |
Invalid Input |
Minato-ku |
Prefecture: * |
Please input data to proceed |
Tokyo |
Postal/Zip: * |
Please input data to proceed
Format should be: XXX-XXXX |
106-8800 |
Business tel: * |
Please include phone number with hyphens. |
03-4588-0687 |
Business e-mail: * |
Please input data to proceed |
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Business fax: |
Please include fax number with hyphens. |
03-4588-0687 |
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Employment History |
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Previous Company |
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Company name: * |
Please input data to proceed |
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Company location: * |
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Started employment: * |
Please input data to proceed |
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Ended employment: * |
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Position: * |
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Personal |
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Other clubs and association memberships: |
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Do you or anyone covered under this application have body markings or tattoos? * |
Please input data to proceed |
The presence of a body marking or tattoo does not imply any negative or positive impact on a prospective Member’s application. |
Please state name of person with tattoo: * |
Please input data to proceed |
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How did you find out about Tokyo American Club? * |
Please input data to proceed |
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Please specify how you found out about the Club? |
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Why do you want to join the Club? Please check all that apply. |
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Why join the club (other) |
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Billing and Mailing Information |
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Mailing address for Club magazine: * |
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Preferred e-mail address for communications: * |
Please input data to proceed |
This e-mail address will be used for all Club communications and monthly statements |
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Personal |
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Background
Explain how your professional and educational background aligns with those of the membership.
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* |
Please input data to proceed |
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English language ability
If English is not your native tongue, please detail your English-speaking ability.
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* |
Please input data to proceed |
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Financial Status
Confirm your ability to meet your financial obligations as a Member.
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* |
Please input data to proceed |
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Characteristics and Club values
Explain how your personal qualities align with the values and culture of the Club. |
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* |
Please input data to proceed |
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Interests
Highlight any interests you have and explain how you intend to immerse yourself in the Club community.
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* |
Please input data to proceed |
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Motivation
Share why you want to join Tokyo American Club. |
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* |
Please input data to proceed |
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Company Transfer Membership |
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Replacing Member Name |
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First name: |
Invalid Input |
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Last Name: |
Invalid Input |
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Membership no: |
Invalid Input |
Please fill in full membership number (ie. 00000-00) |
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Checklist |
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To complete your online application, please submit the following to the Membership Office. |
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Please download and complete the Diners Club card application:
Diners Club Registration Form
You will receive links to share with your Proposer and Seconder in the application confirmation email.
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To complete your online application, please submit the following to the Membership Office. |
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I certify that all the statements made in this application are true to the best of my knowledge and, if I am elected to the Membership, I pledge to abide by the Club Articles of Association, General Rules, House Rules and any other applicable regulations and policies.
I hereby declare that neither I nor anyone within my application have been convicted of any crimes or pled guilty or nolo contendere (no contest) to any crimes in Japan or elsewhere.
I also certify that neither I nor anyone within my application has ever had any dealings with any organized crime group or with persons related to any organized crime group.
I certify that I will keep the Club informed of any change of status regarding the information provided in this application.
I hereby give my consent to a full background check by the Club. |
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