Request Transaction Form

Thank you for your consideration.

If you prefer gift through transactions from Japan Post Bank or branches of Mizuho Bank and Bank of Tokyo-Mitsubishi UFJ, please send us the filled form by clicking the "Send" button located at the buttom part of this page. An transaction form will be send to the informed address.

Last Name
First Name
Honorific
Address
e.g. 475 Riverside Drive,
　　　Suite 439, New York, NY 10115
Phone no.
e.g. +81-422-33-3041
E-mail
e.g. foi@icu.ac.jp
You are A/AN
FOI No./ Student ID No./ Graduated year/ RID & club n.(Rotarian)
e.g. F123456、s123456、c012345z、2001、
RID2750, Tokyo Mitaka Club
Donation to be used for
Please see "Overview” for detailed information of aims and purposes.
Check here if you would like your donation to be anonymous.
Comment
Please indicate the group's name here,for donation to PBS or Artificial Turf.