Application Form
【Grand Prize】Fukuoka Prize 2022 Public Lecture
by Mr. Hayashi Eitetsu
This is a page for application for the public lecture by Mr. Hayashi Eitetsu.

Date: 19:00-20:30 Wednesday 28th September
Venue:Denki Building Kyosokan Mirai Hall
(4th Floor Denki Building Kyosokan, 2-1-82 Watanabe-dori, Chuo-ku, Fukuoka, Japan)
Duration of Archived recording can be viewed: from Monday 3rd October to Wednesday 2nd November.


【Application period】
For Onsite attendance:between Monday 1st August to Wednesday 14th September
For Viewing Archived recording: between Monday 1st August to Thursday 29th September


*Style of participation. Please choose one. Onsite (include Archived recording)
Viewing Archived recording only


*Name
(example:John Smith)
*email address   

Confirmation
  

*Contact number
(example:999-9999-9999)
*Address Fukuoka City
Outside Fukuoka City (In Japan)
Outside Japan


*Age group Teens and under
20's
30's
40's
50's
60's and over


Name of companion

Age group of companion Teens and under
20's
30's
40's
50's
60's and over


How many times have you participated in or watched public lecture of Fukuoka Prize before? (selection) 1st time
2nd time
3rd time
4th time and more


How did you know about the public lecture of Fukuoka Prize? (Multiple answers allowed) Fukuoka Prize website or SNS
Fukuoka Prize Flyer
Fukuoka Prize Poster
email newsletter from Fukuoka Prize
Fukuoka Shisei-dayori (City newsletter)
Newspaper or magazines
School
Friends
From internet (excluding Fukuoka Prize website)
Others


*Consent for the Handling of Personal Information I agree




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Secretariat of Fukuoka Prize 2022 Public Lecture
c/o Japan Convention Services, Inc.
Email:32acprize-pl@convention.co.jp
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