Japan-America Society of Indiana

Columbus Japanese Business Association
WE PRAY FOR JAPAN

With Support from
Japan-America Society of Indiana

Sunday, May 8, 2011, 11:00 am – 6:00 pm
Crump Theater
425 Thrid, Street, Columbus, IN 47201

Contact Information　(代表者のご連絡先)

恐れ入りますが、英語でのご入力をお願いいたします。

     Name 
    
Title 
Company 
Address 
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State 
Zip Code 

    Phone 
    
Email 

Advanced Tickets（前売り券）:

All-Day Concert Pass（コンサート・一日通し券）: $20.00 　
Children Under 12　 (12歳以下のお子様)：Free

Individual Tickets to each concert is available at the door with $10.00.
各コンサート毎のチケットは、 $10.00 (当日販売のみ。各コンサートに一枚必要です

お申込みチケット数:

All-Day Concert Pass（コンサート・一日通し券）:
Children Under 12 (free of charge)(12歳以下のお子様の人数):

Payment Method　(お支払い方法)

Mail Check　(小切手郵送)
Make check payable to "Japan Earthquake Relief Fund"　
(小切手のあて先は、"Japan Earthquake Relief Fund"。下記住所まで、小切手をお送りください):　
Japan-America Society of Indiana, Inc
Union Station
39 West Jackson Place, Suite 50
Indianapolis, IN 46225

Online Credit Card　(オンラインでのお支払い)
If you celect to pay by credit card you will be taken to a form immediately after this form has been successfully submitted.
(下記、お申込みボタンをクリックした後、オンラインでのお支払い画面に進みます)

Columbus Japanese Business Association WE PRAY FOR JAPAN

With Support from Japan-America Society of Indiana