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["社会人リーグ審判講習会参加名簿"]
[]
["フリガナ",null,"※"]
["氏名",null,"※"]
["生年月日"]
["所属チーム名",null,"※"]
["チーム内役割　　○印　　　　"," 監督・ コーチ・ 選手・ その他（　　　 ）"]
["現住所郵便番号",null,"※"]
["現住所",null,"※"]
["ＴＥＬ"]
["ＦＡＸ"]
["携帯電話＆Ｅメール","　　　　　　　　　　　　　　　　　　　　　．","※"]
["パソコン用メールアドレス",null,"※"]
["勤務先名"]
["勤務先〒／住所","〒　　　　　　　　　／"]
["ＴＥＬ"]
["ＦＡＸ"]
["※要記入（特にパソコン用メールアドレスをお持ちの方はルール変更等送りたいと思いますのでお願いします）"]
["※この書類は個人情報保護に細心の注意を払い取り扱います。"]
["※この書類の送り先　FAX０９４４－８７－０８０９　mail　t-fukushima@mbc.nifty.com"]