I apply for Exhibit of an Idea/Work

Name
Family Name Given Name
Company/Organization

Date of Birth
 19yearmonthday

Sex
Mr.   Ms.

Postal Code


Postal Address
Country      Prefecture/State
City  
Street & Number    
Residence Name(If any)

Telephone Number


FAX Number


E-mail address



Request for posting of an idea/work on Japanese Homepage
I DO request.(I apply for the translation service.)
I make an Application in Japanese.(To Japanese Application Form).)
I DO NOT request.


Title of the idea/work



Type of idea/work
Copyright Work   Invention   Utility Model   Design   Trademark
Type of new plant   Configuration of Semiconductor Circuit   Trade   Portrait/Character

Summary of the Idea/work


Please express your idea/work in the form of 'haiku'(short poem).(If you like)


Your suggested sales price
JPY