RESERVE

Tickets for the Champagne Ball are ¥12,000 per person and can be reserved until November 17th (Thu) at 12:00 noon.

Please reserve by using the form below.

Please contact Champagne Ball administration at
(052) 229-1525 or via email at
info@champagne-ball.com if you have any questions.

Payment by bank transfer:
Mitsubishi Tokyo UFJ Bank, Moriyama Branch,
Futsu 0057163
Tokai Nihon Kanada Kyokai Kaikei Gregory Jonathan

(Note: ACCJ members will be invoiced as per regular events)

CHAMPAGNE BALL RESERVATION FORM

(* indicates required fields)

First Name* Last Name*

E-mail*

Primary Phone* Alternate Phone

Organization Affiliation*
 ACCJ TJCS Neither organization

Number of Additional Guests*

Names of Additional Guests (Please separate names with a comma.)

Will you require babysitting services?
 Yes No
If yes, how many children?

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