Application Form

posted on 11/25/2008
closed on 12/10/2008

We have closed application. Thank you.

Thank you for visiting JAPAN TRIP2009 Application Form. The participation process will flow as follows.

1. Please read back the important information again.
2. Submit online Application Form(this form).
3. Responce e-mail is sent automatically to confirm your e-mail address.
4. You have to pay deposit by Dec 12 at the cafeteria or through mail with check to confirm your application.
5. We will have some questionnaires, fix and announce details, and hold pre-trip session.
6. You have to pay the full cost in Februrary(due day is to be announced).
7. Depart to Japan!

---

Fill in the form below and submit ONCE.

* Items marked with star is REQUIRED.

First Name*
Middle Name
Last Name*
Gender*	Male Female
Age*	*we require your age to reserve air ticket in Japan.
Contact E-mail*
School/Organization*	HSPH BUSPH Other(describe right) (other organization)
Program*	Master of Public Health Master of Science(2years) Master of Science(1year) Doctor of PublicHealth/Science/Philosophy Other (choose dominant one.)
Department*	Biostatistics Environmental Health Epidemiology Genetics and Complex Diseases Global Health and Population/International Health Health Law, Bioethics and Human Rights Health Policy and Management Immunology and Infectious Diseases Maternal and Child Health Nutrition Society, Human Development, and Health/Social and Behavioral Science Other (choose dominant one.)
Citizenship*	(e.g. United States of America)
Deposit Payment Preference*	hand check at the cafeteria in HSPH send check through mail We will inform you the details of payment methods.
When you travel by yourself, which kind of accommodation do you use?*	hostel (around $30) standard hotel (around $80) deluxe hotel (around $150)
Room type preference at Kyoto*	Japanese style European twin Our reservations depend on actual availability. You can see the photo of rooms here (click 'Accommodation' and left-side tabs).
What's your background (academic/professional)?
In terms of public health, what are you interested in?
What do you think are the determinants of longevity in Japan?
What do you wish to do in Japan? (Suggestions for activities/places to visit)
Question/Comment

Copyright HSPH Student club of Japan and BUSPH JT Organizing Committee / All Rights Reserved.