Written Pledge
mm dd, yyy

To: Director General, 
National Institute for Physiological Sciences, National Institute of Natural Sciences, 
Representative of Japan-U.S. Brain Research Cooperative Program

　　　　　　　　　　　　　　　　　　　　　Affiliation
　　　　　　　　　　　　　　　　　　　　　Name　　　　　　　　　　　　　seal

I will handle all accidents, etc. during the business trip at my responsibility and will not create a nuisance going abroad on the following business trip.
I hereby pledge as per the above.

1.	Name of research topic

2.	Principal Researcher of Group Joint Study Project　
　　　　　　　Affiliation and post
　　　　　　　Name　　　　　　　　　　　　　　　　　　　Seal

3.	Advisor　　 Affiliation and post
　　　　　　　Name					Seal

4.	Business

5.	Destination of business

6.	 Business trip period	From mm dd, yyyy to mm dd, yyyy	(  days)