Application for refugees

下記フォームへ入力し [ 確 認 ] ボタンを押してください。

first name
sir name
sex
occupation
e-mail address
tel (ex.123-456-789)
Where you live. (ex. Tsukuba, Ibaraki)
nearest station from your house
We will offer you a carfare up to 1000yen. What do you think? That is enough.
I need more.
I do not need.
others
Write more if you chose "others"
If you have any question, feel free to contact us


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