Application Form

If you are unable to send a message using the form below, please send an email to info@wheelchairskijapan.com

Name(required)

Address (Including country name)(required)

Email Address(required)

Mobile Number(required)

Type of disability(required)

Wheelchair type
Self-propelledelectricNot used

Preferred lesson start date

※If an error occurs, please submit the form without entering anything in the "Preferred Date" field

Preferred number of lesson days
12345678910

Accommodation arrangement request
YesNo

Private Shuttle request
YesNo

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