Change of Address

Please click here for JAPANESE
 
ICU is committed to maintaining close relationships with its alumni and friends. If you have recently moved, or have not received any mail from ICU, please update your contact information by sending the form below. Your information will be handled securely in accordance with ICU privacy policy.


Last Name
First Name
Name in Japanese
Previous Name
Date of Birth (To verify individual)
Example)  1949/6/15
Honorific

Relation to ICU
Selection of Alumnus /Alumna
If you choose others, please specify

If you are an alumnus/alumna

Division
Year and Month of Graduation
Example)1980/03
Student ID

Address
Please include your postal code and country here.  If you live in a foreign country that uses Kanji, please use alphabets in this field.

Phone
Example) 0422-33-3041
Fax
Example) 0422-33-3041
Mobile Phone
Example) 090-1234-5678
E-mail Address

Business

Company or Employer Name
Department
Office Phone
Example) 0422-33-3041

About mailing publications
If you check the box, you will not receive any publication such as "The ICU."
Only if you are an alumnus/alumna
If you check the box, your information will not be shared with the ICU Alumni Association.
Remarks

Note 1: if you are resident in U.S.A., Canada or Mexico, your information will be shared with the Japan ICU Foundation (JICUF) in NY, U.S.A., and the publications by ICU will be mailed through JICUF.

Note 2: If you prefer your information not to be shared  with the ICU Alumni Association, please let us know.


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