Namara Ippatsu Entry Form

※は必須項目です。
Name
Name in Japanese
Nickname
Occupation
Gender Male Female
Age
Address
Phone
Mobile
Email

※確認のためにもう一度メールアドレスを入力してください。

Emergency Contact (Name)
Emergency Contact (Phone)
Category Open SKI Open SNOWBOARD Women's Challenge Junior
Ski or Snowboard Ski Snowboard(Regular) Snowboard(Goofy)
Insurance Company Name
Insurance Number
Coments
Understand compliance with the covenants (Full name)(degital sign by legal gardian, if you're under 20)
Confirmed terms and conditoins (Full name)(degital sign by legal gardian, if you're under 20)