以下の基本情報を正確にご入力の上、ご確認ください。

• アカウントID（メールアドレス）*

  このメールアドレスは確認メール用です。正確に入力してください。
• パスワード*

  パスワードは8～15文字、英字と数字を含め、記号は不可。
  パスワードの再確認*
• 名前*

  ローマ字*
  性別*

  男

  女

  その他

  誕生日*
• 国籍*

  選択してください Taiwan(台灣) China(中國) Japan(日本) Hong Kong(香港) Macao(澳門) Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile Christmas Island Cocos Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lion Mountain Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syria Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Yemen Zambia Zimbabwe
  パスポート番号、在留カード番号*
• 電話番号*

  選択してください Taiwan(台灣) (+886) China(中國) (+86) Japan(日本) (+81) Hong Kong(香港) (+852) Macao(澳門) (+853) Afghanistan (+93) Aland Islands (+358) Albania (+355) Algeria (+213) American Samoa (+1 684) Andorra (+376) Angola (+244) Anguilla (+1 264) Antarctica (+672) Antigua and Barbuda (+1 268) Argentina (+54) Armenia (+374) Aruba (+297) Ascension Island (+247) Australia (+61) Austria (+43) Azerbaijan (+994) Bahamas (+1 242) Bahrain (+973) Bangladesh (+880) Barbados (+1 246) Belarus (+375) Belgium (+32) Belize (+501) Benin (+229) Bermuda (+1 441) Bhutan (+975) Bolivia (+591) Bosnia and Herzegovina (+387) Botswana (+267) Bouvet Island (+47) Brazil (+55) British Indian Ocean Territory (+246) Brunei (+673) Bulgaria (+359) Burkina Faso (+226) Burundi (+257) Cambodia (+855) Cameroon (+237) Canada (+1) Cape Verde (+238) Cayman Islands (+1 345 ) Central African Republic (+236) Chad (+235) Chile (+56) Christmas Island (+61) Cocos Islands (+61) Colombia (+57) Comoros (+269) Congo (+243) Cook Islands (+682) Costa Rica (+506) Croatia (+385) Cuba (+53) Cyprus (+357) Czech Republic (+420) Democratic Republic of the Congo (+243) Denmark (+45) Djibouti (+253) Dominica (+1 809/829/849) Dominican Republic (+1 809/829/849) East Timor (+670) Ecuador (+593) Egypt (+20) El Salvador (+503) Eritrea (+291) Estonia (+372) Eswatini (+268) Ethiopia (+251) Falkland Islands (+500) Faroe Islands (+298) Fiji (+679) Finland (+358) France (+33) French Guiana (+594) French Polynesia (+689) French Southern Territories (+33) Gabon (+241) Gambia (+220) Georgia (+995) Germany (+49) Ghana (+233) Gibraltar (+350) Greece (+30) Greenland (+299) Grenada (+1 473 ) Guadeloupe (+590) Guam (+1 671 ) Guatemala (+502) Guernsey (+44) Guinea (+224) Guinea-Bissau (+245) Guyana (+592) Haiti (+509) Heard and McDonald Islands (+61) Honduras (+504) Hungary (+36) Iceland (+354) India (+91) Indonesia (+62) Iran (+98) Iraq (+964) Ireland (+353) Isle of Man (+44) Israel (+972) Italy (+39) Ivory Coast (+225) Jamaica (+1 876) Jersey (+44) Jordan (+962) Kazakhstan (+7) Kenya (+254) Kiribati (+686) Kuwait (+965) Kyrgyzstan (+996) Laos (+856) Latvia (+371) Lebanon (+961) Lesotho (+266) Liberia (+231) Libya (+218) Liechtenstein (+423) Lion Mountain (+232) Lithuania (+370) Luxembourg (+352) Macedonia (+389) Madagascar (+261) Malawi (+265) Malaysia (+60) Maldives (+960) Mali (+223) Malta (+356) Marshall Islands (+692) Martinique (+596) Mauritania (+222) Mauritius (+230) Mayotte (+262) Mexico (+52) Micronesia (+691) Moldova (+373) Monaco (+377) Mongolia (+976) Montserrat (+1 664) Morocco (+212) Mozambique (+258) Myanmar (+95) Namibia (+264) Nauru (+674) Nepal (+977) Netherlands (+31) Netherlands Antilles (+599) New Caledonia (+687) New Zealand (+64) Nicaragua (+505) Niger (+227) Nigeria (+234) Niue (+683) Norfolk Island (+672) North Korea (+850) Northern Mariana Islands (+1 670) Norway (+47) Oman (+968) Pakistan (+92) Palau (+680) Palestine (+970) Panama (+507) Papua New Guinea (+675) Paraguay (+595) Peru (+51) Philippines (+63) Pitcairn (+649) Poland (+48) Portugal (+351) Puerto Rico (+1 787/939) Qatar (+974) Reunion (+262) Romania (+40) Russia (+7) Rwanda (+250) Saint Helena (+290) Saint Kitts and Nevis (+1 869) Saint Lucia (+1 758) Saint Pierre and Miquelon (+508) Saint Vincent and the Grenadines (+1 784) Samoa (+685) San Marino (+378) Sao Tome and Principe (+239) Saudi Arabia (+966) Senegal (+221) Serbia and Montenegro (+381) Seychelles (+248) Singapore (+65) Slovakia (+421) Slovenia (+386) Solomon Islands (+677) Somalia (+252) South Africa (+27) South Georgia and the South Sandwich Islands (+500) South Korea (+82) Spain (+34) Sri Lanka (+94) Sudan (+249) Suriname (+597) Svalbard and Jan Mayen (+47) Sweden (+46) Switzerland (+41) Syria (+963) Tajikistan (+992) Tanzania (+255) Thailand (+66) Togo (+228) Tokelau (+690) Tonga (+676) Trinidad and Tobago (+1 868) Tristan da Cunha (+290) Tunisia (+216) Turkey (+90) Turkmenistan (+993) Turks and Caicos Islands (+1 649) Tuvalu (+688) Uganda (+256) Ukraine (+380) United Arab Emirates (+971) United Kingdom (+44) United States (+1) United States Minor Outlying Islands (+1 671) Uruguay (+598) Uzbekistan (+998) Vanuatu (+678) Vatican City (+39) Venezuela (+58) Vietnam (+84) Virgin Islands, British (+1 284) Virgin Islands, U.S. (+1 340) Wallis and Futuna (+681) Yemen (+967) Zambia (+260) Zimbabwe (+263)

   
  連絡先住所*
• 現職/勤務先および職位*

  学歴*

  選択してください 小学校 中学校 高校 大学 修士 博士
• 会員規約を確認し同意しました。また、横山賞の主催者が提供した個人情報を法令および要項の範囲内で収集、処理、利用することに同意します。
  私はプライバシーポリシーをよく読み、同意します
  
  確認して送信