Keio Academy of New York—Payment Information
Program Fee for Keio Academy of New York Summer Program
Student Name
*
First Name:
Last Name:
Amount
*
US$
(Please write the exact amount indicated in the e-mail.)
*
required item
Billing Information
Name
*
First Name:
Last Name:
E-Mail
*
ex: example@keio.com
*confirmation
Street Address
*
ex: 3 College Road
City
*
ex: Purchase
State
*
ex: NY
Postcode
*
ex: 10577
Country
*
ex: USA
Phone Number
*
ex: 03-1111-1111
Fax Number
ex: 03-1111-1112
*
required item
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