Application for User Registration for the Data Transmission Service for Persons with Print Disabilities

The Director General of the National Diet Library
1-10-1 Nagata-cho, Chiyoda-ku, Tokyo 100-8924 JAPAN


I hereby apply to register as a user of the Data Transmission Service for Persons with Print Disabilities of the National Diet Library.

Date of application:                

Please fill in the following information.

Name(Roman alphabet)	

Date of birth(day/month/year)	

Address	



Country	* If outside Japan.


Reason for application	*Please provide a description of your disability that affects reading.



E-mail address	


TEL *Include country code if outside Japan.


FAX *Fill in if you prefer to be contacted by FAX. Include country code if outside Japan.