Please send the completed and signed form (Page 1-2 required. Page 3 optional) to ACCJ

by email or fax (03) 3433-8454. Fields marked with an asterisk (*) are required.

Reasons for joining (goals and aspirations) e.g., Advocacy, Networking, Information
Membership Category*
Please select one.
Corporate Sustaining Membership / Representative Member (CSR) / Additional Member (CSA/CSN)
Company Membership / Representative Member (CMR) / Additional Member (CMA/CMN)
If you selected “CSA/CSN” or “CMA/CMN,” please write the name of your membership’s Representative Member on the line below.
Representative Member:
(Note: Membership dues & entrance/transfer fees will be charged to above Representative Member’s account. The ACCJ is not responsible for any internal approval process for member companies.)
If this is a member transfer, please write the name and member ID of the resigning member.
Resigning Member: / Member ID:
Member Data
Please write your name here as you would like it to appear on ACCJ printed materials.
First name*: / Middle name:
Last name*: / Suffix (Jr./Sr./III):
Title (please check one)*: Mr. Ms. Dr. Other ()
Gender*: Male Female / Citizenship*:
Date of birth (mm/dd/yy):
Name of last school attended:
Degree (list highest degree earned): / Country:
English ability (please check one): fluent good minimal none
Japanese ability (please check one): fluent good minimal none
Home address (optional)
Bldg. name:
Street number: / Street /Area/ Ward:
City: / Prefecture/State:
Country: / Postal code:
Home phone: / Home fax:
Company name*:
Title/Department:
Mailing address*
Bldg. name:
Street number: / Street /Area/ Ward:
City: / Prefecture/State:
Country: / Postal code:
Office Phone: / Office Fax:
Alternate contact number: / Cellular Phone Fax
Email address for receiving ACCJ communications*:
Email address for Directory listing (if different from above):
Personal Data Private Opt-in/Opt-out (Failure to make any selections will default all choices as no.)
- / Do you want to show your general company contact information (company name, title in organization, company email address, company telephone number, and company fax)
to members? Yes No to non-members? Yes No
- / Do you want to show your direct contact information (mailing address and your email address)
to members? Yes No to non-members? Yes No
Note: The settings above will be reflected in the online Membership Directory of the ACCJ website and used when/if the ACCJ office receives inquiries from members and non-members. The annual Membership Directory is compiled yearly between November and December and is published in the spring of the following year. Since appearing in and receiving the annual Membership Directory are considered to be important benefits of ACCJ membership, it is assumed that all members will want to have their contact information appear in the annual Membership Directory. You will be contacted at that time to confirm your listing for the Directory.
Mailing Label Preferences (Failure to make any selections will default all choices as no.)
The ACCJ sells adhesive mailing labels drawn from our member database (name, title, company name and mailing address) for both member and non-member purchase.
Would you like to be listed in ACCJ mailing labels?
Yes No
Please go to <http://www.accj.or.jp/privacy-policy to see ACCJ Privacy Policy.
Please note that the ACCJ may share your name, title, company name and mailing address with vendors and strategic partners for providing you with membership services.
Agreement [1)]
The undersigned, if and when accepted as a member, agrees to be bound by the Constitution and Bylaws of the Chamber. Further, the undersigned acknowledges having read and understood the ACCJ Privacy Policy as provided in this packet. As set forth in the Constitution and Bylaws, the undersigned also agrees that membership dues shall be paid annually, and fees, if any, shall be paid monthly upon receipt of an invoice from the ACCJ.
Signature*: / Date (mm/dd/yy):
Note: Unsigned applications will not be accepted.

Committee Signup (Optional)

Name:

The ACCJ has numerous programs, events, and industry-specific meetings hosted by committees, subcommittees, and task forces. Each provides a chance for you to gain valuable information and expand your contacts. To see committee descriptions, please visit our website www.accj.or.jp. Please check the boxes next to the committees you want to join. You will start receiving emails from the selected committees. You may add or remove committees online anytime.

Aerospace and Defense Committee* / Insurance Committee*
American Automotive Industries Committee* / Intellectual Property Committee
Banking, Finance and Capital Markets Committee / Investment Management Committee*
Charity Ball Committee* / Alternative Investments Subcommittee
Competition Policy Task Force / Japan Structural Reform Task Force*
Direct Marketing Committee / Legal Services Committee
Education Task Force* / Marketing Programs Committee
Energy Committee / Membership Relations Committee*
Environment Committee / Japanese Membership Relations Subcommittee*
Food and Agriculture Committee / Olympics and Sports Business Committee
Foreign Direct Investment Committee / Real Estate Committee
Globalization Committee / Integrated Resorts Task Force
Government Relations Committee / Retail Committee
Growth Strategy Task Force / Sales Development Committee
Healthcare Committee / Special Events Committee
Regenerative Medicine and Bioscience Subcommittee / Sustainability Committee
Dietary Supplements Subcommittee / Taxation Committee
Healthcare IT Subcommittee / Toiletries, Cosmetics and Fragrances Committee*
Medical Devices and Diagnostics Subcommittee / Tourism Industry Committee
Pharmaceuticals Subcommittee / Transportation and Logistics Committee
High Performance Computing Task Force* / University Briefing Committee*
Human Resource Management Committee / U.S.-Japan Regional Leadership Committee
Independent Business Committee / Women in Business Committee
Information, Communications & Technology Committee / Women in Leadership Subcommittee*
Internet Economy Task Force / Young Professionals Forum*
Kansai Chapter / Chubu Chapter
Business Programs Committee / Aerospace Industry Subcommittee**
Community Service Committee / Business Programs Committee
External Affairs Committee / Community Service Committee
Living in Kansai Committee / External Affairs Committee
Membership Committee / Independent Business Committee
Women in Business Committee / Living in Chubu Committee
Membership Relations Committee
Women in Business Committee

**This subcommittee is under the Aerospace and Defense Committee

Note 1: Committees marked with an asterisk (*) require approval from the chair.

Note 2: Members are advised that upon signing up for a committee, the new committee member's name, phone number, and email address may be forwarded to the committee chair to allow the chair to establish initial contact with you.

1

RVSD: 2016.07

[1)] ACCJ memberships renew automatically on the annual anniversary of the date on which you became a member. The ACCJ bills annual membership dues three months before your new membership cycle begins to give you ample time to pay or to let us know before your current membership expires if for any reason you do not want your membership to automatically renew.

Bills still unpaid two months after the due date are deemed delinquent and may lead to loss of membership. If you wish to resign or cancel your membership, you must give written notice to the ACCJ Executive Director at least one calendar month beforehand. Until your written notice is received, your membership remains active and your membership dues will continue to accrue for the prorated month(s).