Donation Form STEP1 Apply STEP2 Confirm STEP3 Submit ※Required Target and Amount Target and Amount Donations to the 150th Anniversary Fund（General fund） Donation amount（JPY） Please enter your donation amount Please enter your donation amount 10,000 yen 20,000 yen 30,000 yen 50,000 yen 100,000 yen enter amount （ yen） We accept donations of 1,000 yen or more. Commas not needed. Reason for donation What/Who prompted you to donate? Please select Hokkaido University 150th Anniversary Special Website Hokkaido University 150th Anniversary Fund Website Alumni association Family members Acquaintances Hokkaido University faculty or staff Social media Other Donor Details Donor Type Please select Individual Corporate Name Last Name: First Name: Company/Organization Position Representative Last Name: First Name: Department Contact person Last Name: First Name: Address Line 1: City, State, ZIP: Country: E-mail address Re-enter for confirmation: Your relationship with Hokkaido University Please select Alumni Current Student Parent of Student Faculty & Staff Former faculty & staff Other Message of support Your name, message, and the target of donation may be posted to our website. If you wish to be anonymous, please tick the box below. Anonymous Online Donor List The name of the donor will be listed on the 150th Anniversary website.（The amount and purpose of the donation will not be stated.）If you do not wish your name to be listed, please tick the box below. Do not include in the list. Gifts If you do not wish to receive a thank-you gift, please tick the box below.Click here for more information on donor benefits. I do not wish to receive a thank-you gift. Donor nameplate（Only for donors of 200,000 yen or more） If you do not wish your nameplate to be displayed, please tick the box below.Click here for more information about the Donor nameplates. I do not wish my nameplate to be displayed. Updates from the University We send PR magazines on a regular basis by mail, as well as monthly e-Newsletters by email. If you do not wish to receive them, please tick the box below. I do not wish to receive PR magazines. I do not wish to receive e-newsletters. Payment Methods Credit card Bank transfer Your credit card information has not been entered. Failed to tokenize credit card information. Credit card number A credit card number must contain 16 digits without hyphens. Card expiry date 01 02 03 04 05 06 07 08 09 10 11 12 Month 23 24 25 26 27 28 29 30 31 32 Year Security code The card security code is a set of three or four digits on your credit card. Receipt will be delivered 2-3 months after submitting the application. The receipt will be dated based on the date of transfer from the credit card company to Hokkaido University. Please transfer the money to Hokkaido University using the account details below.Donors are responsible for any transaction fees. REMITTANCE 【WIRE／TRANSFER】INSTRUCTIONS: BANK NAME NORTH PACIFIC BANK LTD. BRANCH NAME KITA 7 JO BRANCH BRANCH ADDRESS Kita 7 Nishi 4 Kita-ku Sapporo 060-0807 JAPAN SWIFT code/BIC NORPJPJP BENEFICIARY'S ACCOUNT NUMBER 3825966 BENEFICIARY'S NAME Hokkaido University BENEFICIARY’S ADDRESS Kita 8 Nishi 5 Kita-Ku Sapporo 060-0808 Japan Proceed to Confirmation
