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["出前講座（市民)情報登録票"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"記入日       年       月       日"]
["関市生涯学習課　宛"]
["関市生涯学習情報システムの出前講座情報への　　　　　　　　　　　　　　　　　　　　　　を申請します。"]
[]
["講座メニューNo.",null,null,null,null,null,"分類",null,null,null,null,null,null,null,null,null,null,"登録\n　　　　　年月日　　　\n更新"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　"]
[]
[]
["講座メニュー",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"登録形態　※非公開"]
[]
["フリガナ",null,null,null,null,null,null,null,null,null,null,null,"自認する性別",null,null,"生年月日　※非公開"]
[]
["氏名\n団体名",null,null,null,null,null,null,null,null,null,null,null,"\n\n",null,null,"年　月　日"]
[]
[]
[]
["連絡先　※非公開"]
[]
["住所\n※非公開","〒",null,null,null,null,null,null,null,null,null,null,null,null,null,"電話\n※非公開"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX\n※非公開"]
[]
[]
["フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"携帯電話\n※非公開"]
["連絡先氏名\n※非公開"]
[]
["出前エリア\n※非公開\n※複数回答可"]
[]
["スタイル",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〔　　 〕"]
[]
["講座内容について"]
["内容"]
[]
[]
[]
[]
[]
[]
["対象\n※複数回答可",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〔　　　〕",null,null,null,"講座時間"]
[]
["学習者が用意するもの"]
[]
[]
["交通費",null,null,null,null,null,null,"〔　　円〕",null,null,null,null,"備考"]
[]
["※　　　 内の情報については、ホームページ等へ掲載し、情報提供を行います。"]
["※　　　 内の情報については、ホームページ等へ掲載は行わず、非公開とします。"]
["※ご提供いただきました情報は、当システムの目的以外には使用いたしません。"]
[]
["以下３つの事項にあてはまる場合は、チェックしてください。すべてあてはまる場合のみ、生涯学習情報システムに登録できます。"]
[]
[]
[]
[]
[]
[]
[]
["　関市生涯学習情報システムの出前講座情報に登録し、情報を提供することに同意します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]