Application Form for admission to Japan Christmas Rose Society- Helleborus

Please send this form to us at the e-mail address after filling in the blanks.


 Full Name  
Gender         Male        Female
Post Code (〒) 〒       −
Phone No.
E-mail Address                      @
Application Date
Scheduled Payment Date

Bank Name Tokyo Mitsubishi UFJ Bank, Kichijoji
Account No. Savings(Deposit) Account No.2622040
Name of Account Japan Christmas Rose Society Net Guchi

(Note) The member's card and its badge will be sent to you within 2 weeks
after we confirm your payment.