Application form

Premium membership application form:

  1. Step 1 Enter Required Information
  2. Step 2 Confirmation

  3. Step 3 Completion

* Fields marked with a * are required.

Make a donation

Thank you for your decision. Please enter required information to proceed.

Membership

Please choose your plan.
Annual donation will be renewed every March unless requested by the member.

Donate to*
Designations*
Donate to(other)
Donation Type and Amount*

Select one of the donation methods below and select the donation amount from the pull-down menu.

  • (JPY)
  • (JPY)
  • (JPY)
  • (JPY)
返礼品*




Survey
Reason:
Please feel free to write a comment up to 140 characters.
Input character number:characters

Personal Information

Please enter your information to register as the premium membership.
Questions marked as * are required to ans
Our privacy policy

申込者区分
Name:*
   
Name at the time of graduation*
法人First name*    
法人First nameフリガナ*    
代表者Position*    
代表者漢字Name*    
代表者First nameフリガナ*    
担当者部署*    
担当者漢字Name*    
担当者フリガナ*    
Gender:    
Date of the Birth*  /  /  
Mailing address:*
Address
City / State, ZIP code, Country
Phone: *
Phone:
Fax:
Email:*
Email (Confirmation):*
Relationship*

*Alumni includes the following: Graduates, Master’s/ Ph.D. Students, Current students.
*Multiple choices can be made

Tohoku University ID
What is Tohoku University ID?
*Please enter your ID (2 letters + 8-digit numbers)
Current position:
Company:
Title:
Year you join the company:  
Year you left the company:  
E-newsletter*
Do you want to receive a monthly E-newsletter?
   
Special E-newsletter*
Do you want to receive special E-newsletter in Japanese?
   
Nameplate*
May we post your name on the Lifetime Premium Members' nameplate? *Lifetime premium members only
   
Source
How did you find Tohoku University Alumni Association (Shuyukai)?
Reason:
Please feel free to write a comment of up to 140 characters.
Word counter: characters
Motivation
What make you decide to be the premium member?
Reason:
Please let us know why you are interested in the premium membership.
(140 characters) Word counter: characters
List of donor's name*    
Message
Please send us any message. If you have any questions, please write it here.
(1000 characters)
If you would like to apply for the Alumni Graduation Campaign, please enter the following information in the Message box.
  • Nationality
  • User Name which you would like to use at the Tohoku University Alumni Network

If you are/were a Research Student or Exchange Student at Tohoku University, please enter the following information in the Message box.
(Please select “Other” in the “Relationship” box above.)
  • Classification: Research Student / Exchange Student
  • Year of Enrollment, and Year of Graduation / Completion (estimated):
  • Currently Enrolled: Yes/Not
  • Your Faculty / Graduate School / Department, etc.:


Word counter: characters

Payment – via credit card

  • Credit card payment

Payment can be made with credit cards displayed below:

visa master mufg dc ufj nicos jcb amex diners


Credit Card Number

  • *012345678999999

Expiry Date(MM/YY)

/ *01/25

*Enter only the last two digits of the year

*Please be sure to input the month then the year.

CVV number

*123

In order to prevent unauthorized use of your credit card, please input your CVV number as circled in the example below.

security_1 security_2 security_3

Description of the settlement method

Create Your Fund/Shuyukai My Page

  • You can create Alumni Association/Fund My Page to save your information for the next time you apply or edit your personal data.
    Please check the box below and proceed the process.




Please read the Notices before submitting this form.