Membership Application
Please complete this application form in its entirety in English only.
Membership type *
Please choose a membership type
More information about membership types here.
Category *
Please choose a category
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 Membership Transfer. Parent's Name:
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Senior Membership Transfer. Membership no:
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Personal Information
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
Address Line 1: *
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Ex. Homat House #105
Address Line 2: *
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2-1-2 Azabudai
Address Line 3:
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Minato-ku
City: *
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Tokyo
Postal/Zip: *
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106-8848
Home phone no.:
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03-4588-0687
Personal cell no.: *
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03-4588-0687
Home fax no.:
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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
Highest Education Completed
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
Family Membership
Please supply the information below only if you are applying for Couple/Family membership.
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.: *
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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
Name of Current Company: *
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Position: *
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Type of Business: *
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Please specify business type:
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Business address in Japan
Address Line 1: *
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Tokyo American Club Building 3F
Address Line 2: *
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1-2-1 Azabudai
Address Line 3:
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Minato-ku
City: *
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Tokyo
Postal/Zip: *
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106-8800
Business telephone: *
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03-4588-0687
Business e-mail: *
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Business fax:
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03-4588-0687
Employment History
Previous Company
Company name: *
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Company location: *
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Started employment: *
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Ended employment: *
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Position: *
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Personal
Other clubs and association memberships:
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Personal Statement: *
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Provide reasons for wishing to join Tokyo American Club.
Do you or anyone covered under this application have body markings or tattoos? *
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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: *
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How did you find out about Tokyo American Club?
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Please specify how you found out about the Club?
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Billing and Mailing Information
Mailing address for Club magazine: *
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Preferred e-mail address for communications: *
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This e-mail address will be used for all Club communications and monthly statements
Corporate Transfer Membership
Replacing Member Name
First name:
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Last Name:
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Membership no:
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Please fill in full membership number (ie. 00000-00)
Checklist
To complete your online application, please submit the following to the Membership Office.
  • Recommendation by Proposer
  • Recommendation by Seconder
  • Diners Club Card Registration Form
  • Passport copy for Applicant, Spouse and children if applicable
  • Residence card with current address
  • Marriage certificate
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Please download and complete the following forms:
Proposer Form
Seconder Form
Diners Club Registration Form

Comments:
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Please let us know any other information here (for example: additional children).

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.

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Photo Upload
Upload Your Photo:
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Upload Your Spouse Photo:
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Upload child (1) photo:
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Upload child (2) photo:
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Upload child (3) photo:
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Upload child (4) photo:
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Upload child (5) photo:
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Enter the letters you see: * Enter the letters you see:
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