application form / Crystals and Jems course / Aura-Soma Jewellery

Please apply after checking the participation conditions and plan schedule.Click here for participation conditions and plan details

Please select your desired plan 《Required》	Plan A 1-day participation Plan B 3-day participation Plan C 5-day participation Plan D 7-day participation
Name《Required》
Gender《Required》
Date of birth《Required》	※Example:20160408
Postal code《Required》	※Example:1340083
Address《Required》 ※Course information will be sent through post, so please enter your mailing address	※Example:5-42-3, Nakakasai, Edogawa-ku, Tokyo, 134-0083
Phone number:《Required》
e-mail address:《Required》 ※Couse information will be provided via e-mail. Please ensure that your e-mail settings enable you to receive mail from crystal2018@riva-art.co.jp
Once more for confirmation《Required》
Aura-Soma lecture student ID《Required》 ※Please be sure to enter it if you have one
Name to be listed on certificate of course completion《Required》 ※Please write in Roman letters
Introduced by:
Remarks If you have questions, please enter them here. Example: Want to stay in the same room with another attendee, change to recipient name for mail, etc.

Application form