Application Form Ideas for

Try Zero G 2 by Astronaut Hoshiide

If you are applying as a team, please write down the information of all members.

Deadline: Feb. 24, 2012

Name Address Phone Fax Age E-mail

Important Notes: i. Your application form can be submitted via postal mail, e-mail, fax or website at www.angkasa.gov.my/planetarium. ii. Please submit your application form to the following mailing address : National Space Agency (ANGKASA) National Planetarium Lot 53, Jalan Perdana 50480 Kuala Lumpur Tel : 03 2273 4303/ 5484 Fax : 03 2273 5488 Website : www.angkasa.gov.my/planetarium Email : tkjong@angkasa.gov.my iii. Pictures/images (if any) added together with the application form submitted via e-mail or website must not exceed the size of 2MB. Agreement: Applicants must agree to all the items below: i. Management of Application Idea: ANGKASA & JAXA have the right to modify the idea, conduct the activity in space, and apply the result to public and educational purposes, if needed. Related ideas, images, and pictures of the application idea belong to ANGKASA & JAXA. The images and pictures of the application idea will be open to the public on ANGKASAs & JAXAs website. Anyone may use the images/pictures for public/educational purposes. JAXA and ANGKASA may use the application idea for public/educational purposes even if the idea is not conducted in space. If any of the requirements are violated, even after the idea is accepted as a proposed experiment, the acceptance can be withdrawn. ii. Responsibility of Applicant and Exemption Clause of ANGKASA & JAXA: Applicant must guarantee that the application idea does not violate any legal rights, such as intellectual property rights. If a legal problem related to the application idea arises, the applicant will take full responsibility and must solve the problem. iii. Privacy Policy: The personal information collected through this application will be used only for informing the applicant of the selection result, publication, and events related to this project.

GenderMale Female

Occupation

Name :

Activities for Astronaut Hoshiide to conduct in Kibo.

(Please add pictures/images, if needed.)

Outcome of the activity and the reasons.

(Please add pictures/images, if needed.)