Entry

Donation Information

＊Individual / Corporation	Individual Corporation
＊Name	First name Last name
Sex	Male Female Other No answer
＊Date of birth	year month day
＊Company name
Name of representative	First name Last name
＊Name of the person in charge	First name Last name
＊E-mail address of the person in charge	Please enter again to reconfirm.
＊Address
＊City/State/ZIP
＊Country
Phone number	(Do not include hyphens.)
＊E-mail address	Please type it again to reconfirm.
＊Relationship to university
Student id number
Student name
Department
Student grade	year
The year of graduation	year
Belonging
General
Anonymous	withhold the name withhold an amount

Direct mail	If the option is checked, direct mail will be sent to your registered e-mail address. To receive direct mail
（１） Details of use	Indicate details of the selected contribution use if you would like to provide any. （ 300 characters or less. ）
（２） Reason for contribution	What made you decide to make a contribution? （ 300 characters or less. ）
（３） Sending publications	We may provide you with notices on publications, etc. issued by NINS. If you have a request, indicate so in this column. If you do not have a request, you do not need to fill it in. （ 300 characters or less. ）
（４） For inquiries	If you have inquiries, indicate so in this column. （ 300 characters or less. ）