(2026) Champagne Ball Reservations

Last Name

Ex. Smith

First Name

Ex. John

Your Full Name

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

(姓) フリカナ

(名) フリカナ

Email

Telephone

Organization Affiliation

Please note you do not need to be a member to select your "Organization Affiliation". If you learned of the Ball through friends who are members of one of the organizations, then please select that organization as your "affiliation".

Number of Seats

Names of Guests

Ex: John Smith, Mary Smith, Taro Yamada, Keiko Yamada

Primary Guest (1)

First NameLast Name

Additional Guest (2)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

2nd Additional Guest (3)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

3rd Additional Guest (4)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

4th Additional Guest (5)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

5th Additional Guest (6)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

6th Additional Guest (7)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

7th Additional Guest (8)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

8th Additional Guest (9)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

9th Additional Guest (10)

First Name (Given Name) Ex. JohnLast Name (Family Name) Ex. Smith

Total to Pay

ACCJ Members will be billed via their Member accounts.

Total Event Fees

As an ACCJ Member, you will be billed through your ACCJ account.

Payment Method

Display Payment Method

Seating Requests?

Questions or Comments

カード支払い / Card Transaction

JPYDescription

カード情報 / Card Details

Please note that you must register at least one (1) participant to send this form.
"Number of Seats" must be greater than zero (0).

Attendance

カード支払い / Card Transaction

カード情報 / Card Details