Regostration <Clown Camp KISO>

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We use personal information that you send for registration only for Clown Camp Kiso and relative information only.

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Please note that all fields followed by an asterisk must be filled in.
Full Name: *
Clown Name: *Indicate on your name tug.
Email *
If you have only mobile emai, please write down here.
telephone *
Address *
City *
State *
Country *
Postal Code *
Date of Birth * day/month/year
under 18 years * No
Yes
Sex * Female
Male
Program * Registeration for both program, please check both.
 Pre-Program: 25th June- 28th June
 Main Program: 29th June- 2nd July
Course *
Accommodation Choice * Komaoh (4person/per room)
Komaoh (single use)
Hotel (twin)
Hotel (single)
Payment Method * Credit Card (Through Paypal)
Paypal
 Room Mate prefrence Room mate1
Room mate2
Room mate3
Room mate4
Message Physical condition.etc. If you would like to share the information. If you have any request or question, please feel free to write down.
 If you are under age 18 years old.
Name of Parents or Guardian
Parents email
Parents telephone
Name of Attendant If parents attend with, no neccesary to fill.
Agreement ви I am not agree with the guideline.
I agree with the guideline and register the program.
Please note that all fields followed by an asterisk must be filled in.
 

Clown Camp KISO office
302, 6-7-7 Minami-Oi, Shinagawa-ku
Tokyo JAPAN 140-0013