Member registration

Name*

Last：

First：

Name in Katakana (ask reception for help)*

Last：

First：

Email*

Confirm Email*

Phone number*

Example) 09012345678 (Half-width・No Hyphen)

Emergency Contact Telephone No:（Someone besides yourself）*

Example) 09000000000 (Half-width・No Hyphen)
※Someone to contact in case of an emergency while you are using the gym.

Postal Code*

Example）5310075

Prefecture*

【Select】 Hokkaido Aomori Iwate Akita Miyagi Yamagata Fukushima Tochigi Gunma Ibaraki Saitama Tokyo Chiba Kanagawa Yamanashi Nagano Niigata Toyama Ishikawa Fukui Shizuoka Gifu Aichi Mie Shiga Kyoto Osaka Hyogo Nara Wakayama Tokushima Kagawa Ehime Kochi Tottori Shimane Okayama Hiroshima Yamaguchi Fukuoka Saga Nagasaki Oita Kumamoto Miyazaki Kagoshima Okinawa

City*

Street

Building name/number・room number

Blood type*

【Select】 A B O AB I don`t know

Sex

Male

Female

Date of Birth*

Western Calendar Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
※If you are under 18 years old / high school age or younger,your guardian`s consent（guardian`s consent form） is required

Occupation*

【Select】 Salaried Individual Civil Servant Self-employed Student Homemaker Other

Climbing history

Years months   first time

Do you need climbing shoes?

yes

no

shoe size

【Select】 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20 20.5 21 21.5 22 22.5 23 23.5 24 24.5 25 25.5 26 26.5 27 27.5 28 28.5 29 29.5 30 Other
※Required for those who want rental shoes. ※If there is no applicable size, select [Other]

How did you hear about us?

【Select】 Our homepage Magazine Through a friend Twitter Facebook TV Other

Written Oath

CLIMBING  SPACE  BOLD

I am well aware that sport climbing is very dangerous (including death and serious injury) and that the technology and equipment to ensure safety is not perfect. I also recognize that my reckless conduct could put other participants at great risk. Therefore, when using CLIMBING SPACE BOLD, I will respect the instructions of the staff, make every possible effort to prevent injury and accident, and pay full attention to ensuring the safety of myself and other users. In addition, I understand that I am legally liable to handle the damages to other users and facilities caused by my own gross negligence.

 

I agree to terms of use and written oath