1.Name (Indispensable)

2.Nationality (Indispensable)

3.sex (Indispensable)

 Mr. Ms.

4.E-mail (Indispensable)

5.Phone (Indispensable)

6.Which course are you interested in? (Indispensable)

 Private lesson Semi-private lesson(with your friend/family)

7.How often would you like to take classe(s) each week? (Indispensable)

 Once Twice Three times Five times

8.How time would you like to take classe(s)? (Indispensable)

 60min. 90min. more

9.When would you like to take lessons?(Day and time) (Arbitrary)

10.When would you like to start? (Arbitrary)

11.Where would you like to take lessons? (Arbitrary)

Nearest station : / minutes on foot

12.Have you ever study Japanese ( if so， how long )? (Arbitrary)

 yes no

13.Comment: (Arbitrary)