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> 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
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〒
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お名前
※
姓
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フリガナ
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姓
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ご職業
お選びください。
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>管理的職業従事者
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>専門的・技術的職業従事者
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>事務従事者
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>販売従事者
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>サービス職業従事者
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>保安職業従事者
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>農林漁業従事者
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>生産工程従事者
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>輸送・機械運転従事者
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>建設・採掘従事者
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>運搬・清掃・包装等従事者
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>その他
電話番号
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FAX
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メールアドレス
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メールアドレス確認
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会費
※
お選びください。
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>1口×2,000円=2,000円
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>4口×2,000円=8,000円
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>5口×2,000円=10,000円
入金(振込み)方法
※
お選びください。
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>郵便局(ゆうちょ銀行)経由
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>銀行など金融機関経由
入金予定時期
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その他(入会申込みである旨を記入)
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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。