To : UDAC Consortium 
  e-mail:info@udac-consortium.org

                "UDAC Consortium  Application Form"
              ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

We intend to register our name as a member of the UDAC Consortium.

Note: Only apply if you have read and agree to the Terms and
Conditions of Application (see below).

Please write in BLOCK CAPITALS in ink.

   Date:

   Company:
       * This will be added to the list of members on our website.

   Contact Name:  Mr. / Ms. / (           )

   Position:

   Department:

   Full mailing Address:

   Phone:

   Fax:

   E-mail:

   Company website:
            English     http://
            Japanese    http://
       * This will be added to the list of members on our website.

   Year Established:

   Number of Employee:

   Capital stock:

   Business Summary:

   Primary Product or Service:

   Parent Company Name (if any):


[UDAC000103401A23]