Application for Wa Directory
Submit this form and send your portrait image (Approx. 2 Meg.) to wa.ikebana@gmail.com. Don't include information that you don't wish to publish.
Name
*
First Name
Last Name
Email
*
example@example.com
Would you like to publish your email address in the directory?
Yes
No
Phone Number
Would you like to publish your phone number in the directory?
Yes
No
Ikebana School
Address (where are you teaching?)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Would you like to publish your (above) address in the directory?
Yes
No
Artist Profile: About 150 Words (日本語で４００字以内程度）
Website: Full address starting with https://
Instagram: Full address starting with https://
Facebook: Full address starting with https://
Twitter: Full address starting with https://
Pinterest: Full address starting with https://
LinkedIn: Full address starting with https://
Submit
Should be Empty: