CYBERDYNE STUDIO Booking Request Form Fields marked with * are required. Group Tour* RequestDo not request Number of Participants Adults (JPY 1,400) Students (JPY 1,100) Preschool Children (Free) Accompanying Staff* (Free / Up to 3 persons) Note: “Accompanying staff” refers to tour conductors, interpreters, or other supervisors who accompany the group to assist with group activities. Up to three persons may join free of charge. If more than three accompanying staff are required, please include them under “Adults” or “Students.” Applications consisting only of accompanying staff are not accepted. Tour Language JapaneseEnglish (Additional fee: JPY 10,000)With own interpreter Note: Languages other than English are not supported. Please arrange your own interpreter if required. HAL® Try-on Experience* RequestDo not request HAL Lower-Limb Type (JPY 15,000 per person) HAL Lumbar Type (Flat rate: JPY 10,000 for up to 2 people / JPY 3,000 per additional person) Facility Rental* RequestDo not request Requested Facilities Exhibition AreaOmniVisionSeminar RoomNeuro HALFIT Area Preferred Date* First Choice* Second Choice Third Choice Note: If you wish to request multiple consecutive days, please enter the first date and provide details (number of days, etc.) in the “Inquiries / Notes” section. Transportation* (Please select)Public Transportation (Train / Bus)On FootPrivate Car / Motorcycle / BicycleTaxiLarge / Medium BusOther Company / Organization Name Address* (Select country)AFGHANISTANALAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMAS, THEBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANST.BARTHELEMYBOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBR INDIAN OCEAN TERRBRAZILBRITISH VIRGIN IS.BRUNEIBULGARIABURKINABURMABURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REP.CHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGO, DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICACOTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND (IS MALVINAS)FAROE ISLANDSFED STATES MICRONESIAFIJIFINLANDFR SO & ANTARCTIC LNDSFRANCEFRENCH GUIANAFRENCH POLYNESIAGABONGAMBIA, THEGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD IS&MCDONALD ISLSHONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELANDISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA, REPUBLIC OFKOREA,DEM PEOPLES REPKUWAITKYRGYZSTANLAOSLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACAUMACEDONIAMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMAN, ISLE OFMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSST.MARTINMEXICOMOLDOVAMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUENAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISNORWAYOMANPAKISTANPAULAU REPUBLIC OFPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRN ISLANDSPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIARWANDAS.GEORGIA/S.SANDWIC ISSAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH SUDANSPAINSRI LANKAST LUCIAST. HELENAST. KITTS AND NEVISST. PIERRE AND MIQUELONST. VINCENT/GRENADINESSUDANSURINAMESWAZILANDSWEDENSWITZERLANDSYRIATAIWANTAJIKISTANTANZANIA, UNITED REP OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLTUVALUU.S. MINOR OUTLYING ISLUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESURUGUAYUZBEKISTANVANUATUVATICAN CITYVENEZUELAVIETNAMVIRGIN ISLANDSWALLIS AND FUTUNAWESTERN SAHARAWESTERN SAMOAYEMENZAMBIAZIMBABWE Prefecture / State City Street Address Building Name Phone Number* Note: Please provide a phone number where we can reach you during business hours. Email Address* Contact Person Name* Visiting Group Name* Inquiries / Notes Please specify the breakdown if you have accompanying staff. If your visit spans multiple days, please indicate the number of days. Please include any questions or requests. After reviewing your submission, we will send you the dedicated application form and further information by email. Note: If you do not receive an email from us within three business days, our message may have been filtered as spam. We apologize for the inconvenience, but please contact us by phone. CYBERDYNE STUDIO TEL: +81-29-828-8282 By clicking "Submit" below, I hereby agree to your Privacy Policy. CYBERDYNE STUDIO