入会申し込み

地域政党 日本新生への入会申し込みは下記フォームからお申し込みできます。
なお、以下のフォームで、印の項目は入力必須となっています。漏れのないように入力してください。
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ご住所 ( ! ) Notice: Undefined index: addno in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 199
Call Stack
#TimeMemoryFunctionLocation
10.0002235792{main}( ).../index.php:0
" size="30" maxlength="40" class="txt" /> ( ! ) Notice: Undefined index: add in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 202 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " size="60" maxlength="120" class="txt" /> お名前( ! ) Notice: Undefined index: namae in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 206 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " size="30" maxlength="40" class="txt" />名( ! ) Notice: Undefined index: namae2 in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 206 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " size="30" maxlength="40" class="txt" /> フリガナ( ! ) Notice: Undefined index: furigana in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 210 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " size="30" maxlength="40" class="txt" />名( ! ) Notice: Undefined index: furigana2 in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 210 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " size="30" maxlength="40" class="txt" /> ご職業    電話番号 ( ! ) Notice: Undefined index: tel in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 232 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " class="txt" /> FAX ( ! ) Notice: Undefined index: fax in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 236 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " class="txt" /> メールアドレス ( ! ) Notice: Undefined index: mail in /home/users/1/nipponshinsei/web/nipponshinsei.jp/membership/index.php on line 240 Call Stack #TimeMemoryFunctionLocation 10.0002235792{main}( ).../index.php:0 " class="txt" /> メールアドレス確認
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皆さまから入力いただいた個人情報は、会員名簿の作成、会報の送付等に利用させていただく場合がございます。
それ以外の目的で使用することはございません。