Support Member Number Claim Number

Support member number Claim number

“Japan OLED forum”

Support member application form

and registration content change notification

Please enter the changes in red color, when using it as the change notification

Application date / / / (YY/MM/DD)
Number of units of subscription / units（ Yen）
（50,000 Yen or more, in increments of 50,000 Yen in a year）
Corporate name
Member type / Support member
Industrial field / university, Government and municipal office, Research laboratories, Manufacturing, Others ( )
Homepage URL
Representative / Name
/Official position
Affiliation
Address
Administrative contact person / Name
Affiliation
Address
E-mail
Tel/Fax
Registration regular members
(5 members) / (Name) / (Affiliation) / （E-mail） / Regular membership number
1
2
3
4
5
In case you are expecting an invitation to the Facebook group page, please apply from an individual Facebook address to the secretariat individually. However, it will be deleted in case of becoming non-regular member by the registration change.
Examination items: Enter (A) without fail, and (B) or (C).
(A)Membership qualification
Membership qualification
格 / *Please enter ✔inside the [ ] after confirming that the following requirement in the membership detailed rule are satisfied.
[ ] I hereby agree positively to the development of OLED, and follow the aim of the Japan OLED forum.
(B) Introducer / One of the special member or regular member (Individual introduction, and not the company organization etc.)
Name of introducer
Affiliated organization name and post
Member typeand membership number / Special member SP-
Regular member (Management) RA- -
Regular member (Support) RS- -
Regular member (Individual) RP-
If you are not sure of the Member type or number of the introducer, please contuct tosecretariat fromintroducer.
E-mail address
(C)In case of no introducer / Reason to expect the admission, details of business, etc. (Attachment allowed).

Questions related to official announcement of your corporate name and homepage address

(1)Publishing in the membership list of this forum issued printed matters: Prefer / Do not prefer.

(2)Publishing in the membership list of this forum homepage: Prefer / Do not prefer.

(3)In case of preferring, please enter the following when publishing the post etc. in addition to the above-mentioned corporate name.

Note) Please enter after reading the following precaution statement.

Precaution statement

1. The forum regulations are published in the homepage address of this forum. Please confirm.

1. Fiscal year; From April 1 every year to March 31 next year
2. Representative; Representative name of organization (Units such as company, factory, laboratory, department etc.) participating in this forum.
3. Administrative contact person; The window person making the membership fee payment and exchanging the official document, instead of the representative. (Acceptable even if it is not necessarily a registered regular member.) The invoice will be sent to the administrative contact person.

Precaution statement during registration content change

Please overwrite the change date and change place in red color, and submit in the Word format with the file name as “Change notification”.

Example) When there is change in the registration regular member

Registration regular members
(5 members) / (Name) / (Affiliation) / （E-mail） / Regular membership number
1 / ○○○○ / ○○○ / ○○○○○ / RS-052001-1
2 / ○○○○ / ○○○ / ○○○○○ / RS-052001-2
3 / ○○○○ / ○○○ / ○○○○○ / RS-052001-3
4 / △△△△ / △△△ / △△△△△ / RS-052001-4
5 / ○○○○ / ○○○ / ○○○○○ / RS-052001-5

Secretariat contact person

〒816-8580 Fukuoka Prefecture, Kasuga city Kasuga koen 6-1

Kyushu University industry-academia partnership center FS303

Japan OLED forum secretariat

E-Mail； Tel/Fax；81+92-591-2705