Family name:

First name:

Age:

Date of Birth:

Male / Female:

Address (including country and zip code):

Telephone:

Fax:

E-mail:

English proficiency:

University name (if student):

Field of study:

Number of years of study:

Previous visits to Japan:

Have you applied in previous years?

Interest in Japanese Gardens:

Medical Restrictions: The course is an intensive two weeks which requires a lot of walking. If you have any medical or physical restrictions please note them below.

If you feel there is not detail provided on this application form, please feel free to include an additional letter.

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