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寄付のお申し込みフォーム
ご寄付いただける方は以下のフォームよりお申し込みください。
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Email
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氏名(漢字)
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氏名(ふりがな)
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郵便番号
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住所
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電話番号
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寄付金額
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寄付金振込先
広島銀行 呉支店
（普）3556701
自然共生党 代表 谷本誠一
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