Manga109 Application
メールアドレス (Email address) *
所属している組織をドメインに含むメールアドレスを入力すること (Please write your e-mail address that contains your organization in your domain.)
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Name (First name, Family name)/ 名前(姓 名)
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Affiliation/所属 *
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Current position/身分 *
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Address/住所 (Street/町) *
e.g. 1-1-1 Hongo
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Address/住所 (City/市) *
e.g. Shinjuku
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Address/住所 (State/Province/都道府県) *
e.g. Tokyo
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Address/住所 (Postal Code/郵便番号) *
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Address/住所 (Country/国) *
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Phone number/電話番号 *
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Purpose of the use (more than 20 words) / 利用の目的 (40文字以上) *
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