Membership Application
Please complete this application form in its entirety in English only.
Membership type *
Please choose a membership type		 More information about membership types here.
Category *
Please choose a category
Category *
Please choose a category
Have you been a Tokyo American Club member before?


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Membership no:
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Resignation date:
Invalid Input		 Click year to edit
Senior/Emeritus Membership Transfer. Parent's Name:
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Senior/Emeritus Membership Transfer. Membership no:
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Personal Information
First name: *
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Middle Name:
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Last Name: *
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Gender: *


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Home address in Japan
Address Line 1: *
Invalid Input		 Ex. Homat House #105
Address Line 2: *
Invalid Input		 2-1-2 Azabudai
Address Line 3:
Invalid Input		 Minato-ku
City: *
Invalid Input		 Tokyo
Postal/Zip: *
Invalid Input		 106-8848
Home phone no.:
Invalid Input		 03-4588-0687
Personal cell no.: *
Invalid Input		 03-4588-0687
Home fax no.:
Invalid Input		 03-4588-0687
Home e-mail: *
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Nationality: *
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Date of birth: *
Invalid Input		 Click year to edit
English Ability: *
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Years spent in the United States: *
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Years spent in other English-speaking countries: *
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Education
Highest Education Completed
Name of School: *
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School Location: *
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Graduation year: *
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Degree: *
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Couple Membership
Family Membership
Please supply the information below only if you are applying for Couple/Family membership.
Spouse first name: *
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Spouse middle name:
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Spouse last name: *
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Spouse gender: *


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Spouse nationality: *
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Spouse date of birth: *
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Spouse e-mail: *
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Spouse cell no.: *
Invalid Input		 03-4588-0687
Do you have children?


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Child first name:
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Child middle name:
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Child last name:
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Gender: *


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Child date of birth:
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Child nationality:
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Do you have another child?


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Child first name:
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Child middle name:
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Child last name:
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Gender: *


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Child date of birth:
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Child nationality:
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Do you have another child?


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Child first name:
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Child middle name:
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Child last name:
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Gender: *


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Child date of birth:
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Child nationality:
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Do you have another child?


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Child first name:
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Child middle name:
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Child last name:
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Gender: *


Invalid Input
Child date of birth:
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Child nationality:
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Do you have another child?


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Child first name:
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Child middle name:
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Child last name:
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Child date of birth:
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Gender: *


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Child nationality:
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Current Employment Information
Name of Current Company: *
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Position: *
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Type of Business: *
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Please specify business type:
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Business address in Japan
Address Line 1: *
Invalid Input		 Tokyo American Club Building 3F
Address Line 2: *
Invalid Input		 1-2-1 Azabudai
Address Line 3:
Invalid Input		 Minato-ku
City: *
Invalid Input		 Tokyo
Postal/Zip: *
Invalid Input		 106-8800
Business telephone: *
Invalid Input		 03-4588-0687
Business e-mail: *
Invalid Input
Business fax:
Invalid Input		 03-4588-0687
Employment History
Previous Company
Company name: *
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Company location: *
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Started employment: *
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Ended employment: *
Invalid Input
Position: *
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Personal
Other clubs and association memberships:
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Personal Statement: *
Invalid Input		 Provide reasons for wishing to join Tokyo American Club.
Do you or anyone covered under this application have body markings or tattoos? *


Invalid Input		 The presence of a body marking or tattoo does not imply any negative or positive impact on a prospective Member’s application.
Please state name of person with tattoo: *
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How did you find out about Tokyo American Club?
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Please specify how you found out about the Club?
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Why do you want to join the Club? Please check all that apply.
  • Business activities

  • Dining outlets

  • Event, meeting and catering service

  • Family activities

  • Recreation and fitness facilities

  • Socializing and networking

  • Other

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Why join the club (other)
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Billing and Mailing Information
Mailing address for Club magazine: *



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Preferred e-mail address for communications: *
Invalid Input		 This e-mail address will be used for all Club communications and monthly statements
Company Transfer Membership
Replacing Member Name
First name:
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Last Name:
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Membership no:
Invalid Input		 Please fill in full membership number (ie. 00000-00)
Checklist
To complete your online application, please submit the following to the Membership Office.
  • Recommendation by Proposer

  • Recommendation by Seconder

  • Diners Club Card Registration Form

  • Passport copy for Applicant, Spouse and children if applicable

  • Residence card with current address

  • Marriage certificate

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Please download and complete the following forms:
Proposer Form
Seconder Form
Diners Club Registration Form
To complete your online application, please submit the following to the Membership Office.
  • Passport copy for Applicant, Spouse (if applying for Couple)

  • Marriage Certificate or Jyuminhyo for proof of relationship (if applying for Couple)

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Comments:
Invalid Input		 Please let us know any other information here.

I certify that all the statements made in this application are true to the best of my knowledge and, if I am elected to the Membership, I pledge to abide by the Club Articles of Association, General Rules, House Rules and any other applicable regulations and policies.

I hereby declare that neither I nor anyone within my application have been convicted of any crimes or pled guilty or nolo contendere (no contest) to any crimes in Japan or elsewhere.

I also certify that neither I nor anyone within my application has ever had any dealings with any organized crime group or with persons related to any organized crime group.

I certify that I will keep the Club informed of any change of status regarding the information provided in this application.

I hereby give my consent to a full background check by the Club.

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Photo Upload
Upload Your Photo:
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Upload Your Spouse Photo:
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Upload child (1) photo:
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Upload child (2) photo:
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Upload child (3) photo:
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Upload child (4) photo:
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Upload child (5) photo:
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Upload copy of passport:
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Upload copy of spouse passport:
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Upload Marriage Certificate or Jyuminhyo:
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Enter the letters you see: * Enter the letters you see:
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Wine & Dining

Events & Parties

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Contact

2-1-2 Azabudai, Minato-ku
Tokyo 106-8649
+81 (0)3-4588-0381

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