Application for Working as Visitor Users

in Radiation Areas of RCNP

* Please write in block letters.

DATE

To RCNP Director

Institution :

Position :

Applicant Name :

E-mail address :

I wish to apply as Visitor Users working in Radiation Controlled Areas of RCNP, attaching the Approval sheet and a copy of the Medical certificate.

DATE

You are approved as a radiation worker.

RCNP Director : Tadafumi Kishimoto

Radiation Safety Officer : Tomokazu Suzuki