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Donation Form

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Apply for a donation
make a donation
The amount of a donation
amount : yen
Your Name
Your Company Name
Department
Occupation/Position
Postcode
(example:000-0000)
Address
Phone
- -
FAX - -
Email


※Please re-enter your email address for confirmation
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AJALT may publish the company name as a corporate member
AJALT may not publish the company name

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I have read and agree to "Handling of Personal Data" in the "AJALT Policies on Personal Data Protection."(*)

 

AJALT

2F Toranomon ES Bldg.
3-25-2 Toranomon Minato-ku,
Tokyo 105-0001, Japan