Japan-America Society of Indiana

Japan Earthquake Relief Fund

To make a donation to the Japan Earthquake Relief Fund, please fill out the form below and click the "donate" button at the bottom of the page.

         Name 
        
Title 
Company 
Address 
City 
State 
Zip Code 

        Phone 
        
Email 

This is a:

Company Donation (企業としての寄付金)

Individual Donation (個人としての寄付金)

Donation Amount
(寄付金額)

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Online Credit Card　

To submit your donation information and make your payment, please click on the "Donate" button below.