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入会申し込みフォーム
全国若手市議会議員入会希望のお申し込みフォームです。
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お名前
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Your answer
所属議会(都道府県名から)
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Your answer
所属政党(無所属の場合は「無所属」)
*
Your answer
初当選年月
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Your answer
次期改選年月
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Your answer
住所(事務所可)
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Your answer
上記住所の郵便番号
*
Your answer
上記住所の会員向け手帳への記載可否
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OK
NG
固定電話番号
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FAX
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携帯電話番号
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Your answer
メールアドレス
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Your answer
生年月日
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MM
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DD
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YYYY
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