Multi-purpose Hall Donation Application Form

ST. MARY’S ALUMNI ASSOCIATION
St. Mary’s International School
1-6-19, Seta, Setagaya-ku, Tokyo 158-8668
Tel: 03-3709-3413 Fax: 03-3707-1950
Multi-purpose Hall Donation Application Form
I/We wish to donate: Amount: (¥) or ($) ____________________________________________
(US Dollar donations are exempt from federal income tax under section 501 (a) of the Internal Revenue Code.)
How:
□ Bank Transfer
□ Check
□ Cash
For credit card donations : Go to https://secure.smis.ac.jp/Donate
(No need to fill in this application form for credit card donations)
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Blue Sponsor
Gold Sponsor
Individual Seat Sponsor
Special Recognition Sponsor
¥10,000 - ¥49,999
¥50,000 - ¥100,000
¥150,000 per seat Engraved name plate on seat
¥500,000 +
Recognition by Headmaster and
SMAA Board of Directors
＊ Kindly fill this form and mail/ fax it to the address above ＊
Name to appear on receipt: ____________________________________________________________
Address where receipt should be sent: ___________________________________________________
_________________________________________________________ Postal Code: ________________
Tel: _______________________________ e-mail ____________________________________________
□ I approve of my name or my company name being published on the “Donation Wall”
and/or the chair.
Name to be published: _________________________________________________________
□ I wish to be listed as anonymous.
 Donations in Japanese yen can be given directly to SMIS or sent by bank transfer to:
・ Account Name: St. Mary’s Building Fund (セント･メリーズ･ビルディング･ファンド)
・ Mizuho Bank
Kaminoge Branch Ordinary Account #1688186
 Donations in US Dollars checks made out to Friends of St. Mary’s International School
Send to one of the addresses below:
Friends of St. Mary’s International School
or
Mrs. Yumi Shimokawa
c/o International Schools Services
Development Office
15 Roszel Road, Princeton
St. Mary’s International School
NJ 08543-5910, U.S.A.
1-6-19, Seta, Setagaya-ku, Tokyo, 158-8668 Japan
・ Donations in US Dollars by bank transfer:
・ TD Bank
Friends of St. Mary’s International School
3470 Quakerbridge Road
Account # 7856737247
Mercerville, NJ 08619
Routing # 031201360
U.S.A.
Swift Code: NRTHUS33
・ For credit card donations: Go to https://secure.smis.ac.jp/Donate