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["廃棄物処理業許可講習（新規）受講申込書"]
[]
["※太枠の中を記載してください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日"]
[]
[]
["一般社団法人環境総合研究所 環境関連事業推進協議会 （〇又はㇾ点を記入）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"1.会　員 ",null,null,null,"2.非会員"]
[]
[]
["フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"写真貼付欄"]
["氏　　名"]
["生年月日",null,null,"(西暦）",null,null,null,null,"年",null,null,"月",null,null,"日"]
["年　　齢",null,null,null,null,null,"歳"]
[]
["性　　別",null,null,"（〇又はㇾ点を記入）",null,null,null,null,null,null,"1.男",null,null," 2.女"]
[]
[]
["現住所（番地・マンション、アパート名も記入してください）"]
["〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL:",null,"--ある場合は入力--"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"携帯:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX:",null,"--ある場合は入力--"]
["勤務先名・代表者・社印捺印"]
["社　　名"]
["代表者名"]
[]
["勤務先住所"]
["〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"FAX:"]
[]
["URL:",null,"--ある場合は入力--",null,null,null,null,null,null,null,null,null,"E-mail:"]
[]
["講習区分（希望する課題に○又はレ点を記入）",null,null,null,null,null,null,null,null,null,null,null,null,"講習費用（消費税込）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受 講 料",null,null,"テキスト代",null,null,"合計金額"]
[null,null," 1.収集運搬課程",null,null,null,null,null,null,null,null,null,null,null,1,50000,null,null,7000,null,null,{"$f":"P34+S34","v":57000}]
[null,null," 2.処分課程",null,null,null,null,null,null,null,null,null,null,null,2,75000,null,null,7000,null,null,{"$f":"P35+S35","v":82000}]
[]
[]
["講習会選択"]
[null,"第",null,null,"回","〔","札幌",null,null,"〕 会場",null,null,"(西暦）",null,null,null,null,"年",null,null,"月",null,null,"日","～"]
[null,null,null,null,null,null,null,null,null,null,null,null,"(西暦）",null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[]
[]
[]
["講習費用振込年月日を記入してください",null,null,null,null,null,null,null,null,null,null,null,null,"修了証郵送先"]
[]
["(西暦）",null,null,null,null,"年",null,null,"月",null,null,"日",null,"勤務先に郵送します"]
[]
[]
["受講番号",null,null,null,null,null,null,null,null,null,null,null,null,"ＩＤ"]
[]
["※申込時には受講申込書に写真の貼付、社印の押印は不要です。"]
["※ご記入いただいた個人情報につきましては、当法人が行う講習会でのみ使用させていただきます。"]