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きたむら翔平後援会への寄付
金銭・収支に関わるものですので誤りのないように記入をお願い致します。
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お名前
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ご住所
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お電話番号
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ご職業
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ご寄付いただける金額をお教えください。
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メールアドレス
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日本国籍をお持ちでしょうか
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はい
いいえ
個人名義でのご寄付にお間違いないでしょうか?
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はい
いいえ
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