International Biophilia Rehabilitation Academy
Application to join the IBRC 2009
Your name (Full name,
Example: Jon Sato)
Your e-mail address
Your e-mail address(RETYPE)
Affiliation
Title
PostalCode
Address
Telephone
FAX
Country
Division
A. Hospital
B. Acute term hospital
C. Rehabilitation hospital
D. Terminal care hospital
E. Health Care Facilities for the Elderly
F. Long-term Care Facilities for the Elderly
G. Other institutions for the aged
H. Home Care Service
I. Home-visit Nursing Service
J. Home-visit Rehab Service
K. Day Care Center
L. University / College
M. Research Institute
N. Others
Keyword for the
interesting subject
01 Biophilia
02 Care
03 Nursing
04 Medical treatment
05 Engineering
06 Social science
07 Nutrition
08 Conjugated Domain
09 Welfare apparatus
If you have the
interesting subject without
keyword list, please fill in the suitable word in the following.
The Way to pay Your Participation Fee
1. Before by Paypal
2. At the Venue
3.Pay to the office individually