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이름
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생년월일(예: 1975.07.13)
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연락처(예: 010-8771-9368)
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이메일 주소
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주소
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소속
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신청경로(자세하게 써 주세요.)
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환불 계좌번호(예: 국민은행/81010104055874/홍길동)
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