jp-lesson Registration Form
＜To First Time Users＞
You can see for yourself whether you can connect to jp-lesson using your home computer,
and you can also receive a language counseling session from a Japanese instructor for free.
（Free Connection Test & Counseling Session：Approx. 20 min.）
Please have your webcam and headset ready by your reserved date and time,
and be prepared to commence the connection test. Make sure that you have checked the System Requirements page,
and that your computer meets the requirements.
System Requirements
After filling in the form below, please send it. We will send an e-mail of confirmation after receiving it.
Name:
*
First
Last
Date of Birth:
*
Month
Month
1
2
3
4
5
6
7
8
9
10
11
12
/ Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/ Year
Sex:
*
Male
Female
Country:
*
*your presently living
State or City
:
Address:
*
Phone Number:
*
E-mail Address:
*
E-mail Address Confirmation:
*
Occupation:
*
- - - - - -
Office worker
Student
Self-employed individual
Homemaker
Other
Computer OS:
*
- - - - - -
Windows98SE
WindowsME
Windows2000
WindowsXP
Internet Connection Speed:
*
- - - - - -
DSL(less than1.5Mbps)
ADSL(more than1.5Mbps)
CATV(less than1.5Mbps)
CATV(more than1.5Mbps)
Corporate LAN(more than 10Mbps)
Purpose for Studying Japanese:
*
- - - - - -
Communication
Travel
Hobby
Study in Japan
Business
Employment
JLPT-3rd level
JLPT-2nd level
JLPT -1st level
Others
Level of Japanese:
*
- - - - - -
Beginner
Intermediate low
Intermediate
Intermediate high
Advanced
Japanese Study Experience:
*
- - - - - -
No experience
Less than 6 months
6months - less than 1 year
1year - less than 2 years
2 years - less than 5 years
5 years - less than 10 years
More than 10 years
Hiragana?
No
A little
Port of them
Perfect
Katakana?
No
A little
Port of them
Perfect
Kanji?
No
A little
JLPT4th level
More than JLPT3rd level
Have Webcam?:
*
Yes.
No.
Where did you know jp-lesson?:
*
Google
MSN
Yahoo!
Japan Guide
Hiragana Times
Work in Japan
ELT News
Kansai Flea Market
Other
Free Connection Test & Language Counseling preferred date:
Your TimeZone( For in USA ):
in Others.
in U.S.A.
TimeZone
EST
CST
MST
PST
Alaska
Hawai
Others
date:(Your country date.)
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
2005
/
Time
0:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
22:00
23:00
Daylight Saving Time?
Yes.
No.
Enter any questions you may have here.
Thank you very much!
If the above is correct, please click the "Comfirm" button.
