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第24回日本ロービジョン学会学術総会寄付申込書
中野 泰志先生
第24回日本ロービジョン学会の趣旨に賛同し以下の通り寄付いたします。
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寄付金額
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送金日
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〒番号 例 000-0000
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住所 都道府県よりご入力ください
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担当者名 フリガナ
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