APPLICATION 2015 Toyama Cup Speech Contest Name _________________________________________ In Katakana _______________________________________ Address ______________________________________________________________________________________________ Phone ___________________________ Email ____________________________________________________________ University/College ____________________________________ Teacher __________________________________ Years of Japanese Study High School ______________________ College_________________________ Level of Competition ____________________________________ Have you ever been to Japan? Yes No (If yes, please indicate where, when, how long) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Other experiences related to Japan (Example: Home Stay student, Parent is Japanese National) _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Reason for Participating in the Toyama Cup Speech Contest _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Title of Speech and Summary of Proposed Speech Topic _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ Toyama Cup Speech Contest Application Page 2 Toyama Honorary Friendly Envoy Program Please mark Consent or Not Consent ☐ I have read the outline and information on the Toyama Honorary Friendly Envoy Program and consent to fulfilling the responsibilities as stated under “Duties”. ☐ I have read the outline and information on the Toyama Honorary Friendly Envoy Program and do not consent to fulfilling the responsibilities as stated under “Duties”. Please note that by selecting to not consent, you are not qualified to receive the trip to Toyama as a reward. If the Grand Prize winner indicates non-‐consent on his/her application form, the trip to Toyama as an envoy will be awarded to the runner up. Please complete the application and return by April 15, 2015. Do not include the Honorary Envoy information. After completing the form, scan and email to [email protected] or postal mail to Mr. Lynn Moyers Executive Director Japan-‐America Society of Oregon 221 NW 2nd Ave, Suite 202 Portland, OR 97209 Thank you for your interest in the Toyama Speech Contest.