[APPLICATION FORM]

Following application form should be returned by August 31 to 
pschool-info@cps-jp.org or to +81-78-803-6483 by Fax. E-mail submission
is prefered, but post mail and/or Fax will be acceptable.


-------- cut here ----------- cut here -------------  cut here ----------
 Application for participation in the Planetary School December 4 - 6, 2006

1. Name (family name, first name) __________________________

2. Year of study (M1/M2/D1/D2/D3/postdoc for domestic applicants,
  master's or doctoral students/postdoc etc. for foreign applicants)
  _____________________________

3. Affiliation (Department and Institution)

  ______________________________________________________________________

  ______________________________________________________________________


4. Postal address
  ___________________________________________________________

  ______________________________________________________________

5. Citizenship (Country)   _______________________

6. E-mail address   ______________________________

7. Phone number   ______________________________

8. FAX number     ______________________________

9. Your current research subject(s) or interests (about 400 words);

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


10. Are you planning to exhibit a poster? (Yes/Maybe/No) _________

11. Do you request financial support? (Yes/No) ____