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A New Autonomic Nerve Regulating Therapy

Admission 入会申込

Please apply for IARMS admission in this form.

Application Form for Membership 入会申込フォーム

* is Required fields. * のある欄は必須項目です。

Basic Information 基本情報
Last Name 姓 *
First Name 名 *
Including Middle Name
E-mail 連絡先 *
Except for cellular phone's address 携帯メールアドレス不可
Date of Birth
年 yyyy 月 mm 日 dd
Gender 性別    
Member Type
 会員区分 *

All members approve of a purpose of IARMS and are limited to a person with studies motivation in Ryodoraku medicine and/or Acupuncture therapy. ”Regular Member” is the medical doctor, and the person whom a regular member recommended it, and the board of directors recognized in examination. Therefore, Please make application for a medical doctor as ”Regular Member”,and others (including students) as "Associate Member".

Could you understand and agree with the prospectus of IARMS and the regulations and rules of IARMS activities?


※Classification of 'Regular Member' or 'Associate Member' will be determined by the Board's review and will be notified by e-mail.

Recommender's Name 推薦者名
Recommenders should be regular members 推薦者は正会員に限る。
Home Information 自宅情報
 郵便番号 *
Address 住所 *
Phone Number
Fax Number
Office or School Information 勤務先・在籍校情報
Name of Office/ School
Branch/ Faculty (Department/ School)
Title 役職
Education 学歴情報
Name of University
Department 学部名
Year of Graduation
Degree 学位
Other その他
Specialities 専門

Method of Dues Payment
 会費納入方法 *
Bank Transfer 銀行振込
MIZUHO Bank みずほ銀行 Locations
  • Branch Name 店名 : SAPPORO 札幌支店 Mizuho Bank Sapporo
  • Branch Code 店番 : 813
  • Account No. 口座番号 :   Ordinary Account 普通預金 1808357
  • Account Name 口座名 :
    ”Kokusai Ryodoraku Igakukai” (シャ)コクサイリョウドウラクイガクカイ
Japan Post Bank ゆうちょ銀行 Japan Post Bank
  • Branch Name 店名 : 908
  • Code Number 記号番号 : 19060 - 51361401
  • Account Name 加入者名 :
    ”Kokusai Ryodoraku Igakukai” (シャ)コクサイリョウドウラクイガクカイ

※Please pay from the above bank after joining approval (reply by e-mail).

Do you agree that you can not refund it after paying membership fee?


Files Submission ファイル提出 * Application Form for Membership 入会申込フォーム ()

If you can not submit from this form, please submit a MS Word file containing the above items from here. "
* is Required fields. "
* のある欄は必須項目です。"

* Please attach the same name file to the outgoing mail. 送信メールに同名ファイルを添付してください。

Headquarters / Secretariat
法人本部 / 事務局

c/o IARMS in Nakane Toshie Rehabilitation Internal Medicine Pediatric Clinic, 10-2-1 Minami 32 Jyo-Nishi 10 chome, Minami-ku, Sapporo-shi, Hokkaido, 005-0032, JAPAN.

北海道札幌市南区南32条西10-2-1 中根敏得リハビリテーション内科小児科医院内