Membership Form Simply complete and submit this membership form to become a JAA member. Membership Category* Membership Category Regular — $100 Regular Spouse — $50 Senior (over 65 years) — $60 Senior Spouse — $40 Student — $25 Beiju (over 88 years) — Free Supporting — $300 Silver — $500 Gold — $1,000 Platinum — $2,000 Email Address* Title Title Mr Mrs Ms Miss First Name* Initial Last Name* 漢字氏名 in Kanji (if applicable) Mailing Address City State ZIP Business (if applicable) Position Business Address City State ZIP Business Telephone Business Email Emergency Contact's Name (in the USA) Emergency Contact's Telephone (in the USA) Emergency Contact's Address (in the USA) Emergency Contact's Name (in Japan, if applicable) Emergency Contact's Telephone (in Japan) Date of Birth Additional Donation ($) Total Amount ($) JAA's Notices JAA's Notices I'd like to receive JAA's notices by email Next
