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Membership application form

To apply for membership of the Japanese Society of Public Health,Articles of IncorporationPlease check the above and apply using the form below.

Items marked with "※" are required.

Membership type/Type(*) 　
Note: Graduate students are not eligible for student membership. To apply for student membership, a copy of your student ID card is required. Please submit this to the office.
Email address(*)
Note: Please do not register using a shared email address such as your affiliation.
Email address (for confirmation) /Email (re-type)(*)
Login Password(*)
Till 20 characters and numbers
Question for reminder(*)
Till 100 characters and numbers
Reminder response(*)
Till 100 characters and numbers
Name(*) name: name:
Furigana/Name(re-type) name: name:
Romaji/English name: name:
Gender(*) 　
Date of Birth(*) Year　 Month　 Date

Affiliated institution (place of employment/university)/Institution

Institution name(*)
Furigana/Institution(re-type)
Department (Faculty/Year)(*)
Position/Present position
Zip code/Postal code(*) - 
Address 1(*)
Address 2
Address 3
Phone number/Phone
Extension
Fax Number/Fax

Home

Zip code/Postal code(*) - 
Address 1(*)
Address 2
Address 3
Phone number/Phone
Fax Number/Fax

Other

Registered area (prefecture name)(*)
Occupation/Professional(*)
  • Physician (Education and research)
  • Physician (Medical care)
  • Physician (Administration)
  • Physician (Others)
  • Dentist
  • Pharmacist
  • Veterinarian
  • Public Health Nurse
  • Midwife
  • Nurse, Nursing assistant
  • Dental hygienist, dental technician
  • Clinical technicians (Radiologist, Clinical X-ray technologist, Medical laboratory technologist, Hygiene laboratory technologist)
  • Registered nutritionist, Dietician
  • Physical therapists, occupational therapists, orthoptists, speech-language-hearing therapists/Rehabilitation professionals (Physical therapists, Occupational therapists, Orthoptists, Speech-language-hearing therapists)
  • Personnel for School health and Physical education (incdluding Nursing teacher)
  • Health education/Health education
  • Social science/Social science
  • Health statistics/Health statistics
  • Biology/Physics/Chemistry/Engineering/Environment/Personnel for Biology or Physics or Chemistry or Engineering or Environment
  • Others
Document for application(*)
Name

Letter of recommendation (PDF version)　Letter of recommendation (Word version)

If you don’t have a referral


Note: Please attach the recommendation letter and/or resume with the recommender's seal below (PDF or jpg file), or submit them separately by email or fax after submitting this application.
Mailing Address(*)
Fee transfer method(*) 　 　

Please check

Please send the letter of introduction and, if you are a student, a copy of your student ID to the address below. Please note that undergraduate students will not be exempt from the society fee unless they submit a copy of their student ID. The expiration date of your student ID will be considered your graduation, and when you reach the date of your graduation, you will be considered a regular member and will be charged the membership fee for that year. If you wish to remain a member after graduation, please contact the secretariat.
If you do not know who the introducer is, please send a brief resume (free format) to the secretariat by email attachment, fax, or mail.

Destination

〒160-0022 Tokyo Shinjuku-ku Shinjuku 1-29-8 Koei Building
TEL: 03-3352-4338 FAX: 03-3352-4333
Japan Society of Public Health (General Incorporated Association)
Email: phgakkai＠jpha.or.jp

As a general rule, when compiling a membership list, we will include your name and place of employment.