Private Workshop in Matsudo
Application Form

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Your Information
(Please fill out all fields except for Fax#)

Name
First: Last:

Birthday
Year: Month: Date:

Sex
Male Female
(required for insurance purpose)

Email address


(Retype)

FAX

(only if the email address is not available)


Address

Postal Code
-

Prefecture

City, Street

Phone

(such as 03-1234-5678)


Companion's information(Please input if you bring a companion)

Name
First: Last:

Birthday
Year: Month: Date:

Sex
Male Female
(required for insurance purpose)

Relation


Venue
TI Swim Salon Matsudo(Chiba)

Date and time

Preferred Appointment Date and Time

Secondary choice

Tuition (sales tax included)
(Please select one of options)

JPY54,000 Standard Price(Single)
JPY81,000 Standard Price(Pair)
JPY48,600 Anttendants of private workshop or clinic & counseling(single)
JPY72,900 Anttendants of private workshop or clinic & counseling(pair)

Payment(Please select one of them)

Credit Card Please input the followings.
Wire Transfer Japannet Bank Honten-Eigyobu
Futsu Yokin Account#7977880
(Ka) Total Immersion

We will notify you the invoiced amount via email if you choose wire transfer.
Please complete the transfer within two days after we send you the email.

Credit Card Information

Card Type

Card Number
(4 digits in each field)

Cardholder Name
First Last

Expiration Date
MonthYear


Please read the following information:

  • The receipt of your application will be emailed within 24 hours. Please contact info-e@tiswim.jp if you do not receive it.
  • Your appointment will be confirmed upon either credit card settlement or remittance of the tuition.
  • If you choose "Wire Transfer" as the payment method, please complete remittance within 2 banking business days. Your appointment will be voided after that.
  • Cancellation Policy: Not refundable unless the slot is taken by others. We will let you know the result after the appointment date.

This application is finalized after you click the button below.