Donation Form
Date: MM / DD
Amount of donation:
/ YYYY
JPY
*Please remit your donation in Japanese yen.
Name of company/
organization
Address
Postcode:
Country:
First name
Middle name
Last name
First name
Middle name
Last name
Ms./Mrs./Miss./Mr./Dr.
Representative
Corporate title:
Ms./Mrs./Miss./Mr./Dr.
Corporate title:
Contact person
Phone number: （Country code
）-
E-mail address:
Please check the box if applicable.
❏ We need billing statement.
❏ We prefer to make our donation anonymously.
Japanese Foundation for Cancer Research (JFCR) lists the names of donors on the bulletin board at the outpatient
floor for one year, and on official website. For companies that donate ¥500,000 or more, JFCR creates the donor’s
nameplates to honor them and displays plates at the outpatient floor of the hospital.
3-8-31 Ariake, Koto-ku, Tokyo 135-8550 JAPAN
TEL: +81-3-3570-0401
FAX: +81-3-3520-0141
E-mail: kikaku@ml.jfcr.or.jp