Private Workshop in Matsudo
Application Form

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

First: Last:

Year: Month: Date:

Male Female
(required for insurance purpose)

Email address



Postal Code


City, Street


(such as 03-1234-5678)

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

First: Last:

Year: Month: Date:

Male Female
(required for insurance purpose)


Swim Salon Matsudo(Chiba)

Date and time
(Please select the date based on the availability shown below.)

Preferred Appointment Date and Time
Year: Month: Date: From:

Secondary choice
Year: Month: Date: From:

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

JPY33,000 Standard Price(Single)
JPY55,000 Standard Price(Pair)
JPY27,500 repetitive customer (single)
JPY44,000 repetitive customer (pair)

(Please select one of them)

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

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

Please read the following information:

  • The receipt of your application will be emailed within 24 hours. Please contact 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.