Personal InformationNew Record - Input Form

If you are using a mobile phone carrier email address (docomo, au, softbank, etc.), emails from this system may not be delivered correctly.
Please check your email settings in advance to ensure that you can receive emails from the domain "@nta.co.jp".

For information on how to set this up, please contact your mobile phone company or email service provider. When entering your email address, please be sure to check that it is correct.

Fields with * are required.

Name:
(First Name) (Middle Name) (Family Name)
Prefix:
Country/Region:
E-mail address:
E-mail address (retype):
Password:

* Your password must be a minimum 6 characters, with letters and numbers.

* The system is case-sensitive.
Password (retype):
Affiliation:
Department:
Address:
City:
State/Prefecture/Province:
Zip:
Phone: