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[null,"様式-ウ",null,null,"令和3年度　北信越学生ハンドボール大会傷害保険加入者名簿"]
[]
[]
[]
[]
[null,"    　　　 大学(男・女)",{"$nulls":5},"(申込責任者：　       　連絡先：　　　    -　　     -　　      )"]
[]
[null,"NO","氏　　　名　",null,null,null,"性別",null,"生年月日",null,null,"NO","氏　　　名　",null,null,null,"性別",null,"生年月日"]
[null,1,{"$nulls":9},26]
[null,2,{"$nulls":9},27]
[null,3,{"$nulls":9},28]
[null,4,{"$nulls":9},29]
[null,5,{"$nulls":9},30]
[null,6,{"$nulls":9},31]
[null,7,{"$nulls":9},32]
[null,8,{"$nulls":9},33]
[null,9,{"$nulls":9},34]
[null,10,{"$nulls":9},35]
[null,11,{"$nulls":9},36]
[null,12,{"$nulls":9},37]
[null,13,{"$nulls":9},38]
[null,14,{"$nulls":9},39]
[null,15,{"$nulls":9},40]
[null,16,{"$nulls":9},41]
[null,17,{"$nulls":9},42]
[null,18,{"$nulls":9},43]
[null,19,{"$nulls":9},44]
[null,20,{"$nulls":9},45]
[null,21,{"$nulls":9},46]
[null,22,{"$nulls":9},47]
[null,23,{"$nulls":9},48]
[null,24,{"$nulls":9},49]
[null,25,{"$nulls":9},50]
[]
[null,"※上記NOは加入者数カウント用です。(背番号ではありません)"]
[null,"※部員数により記入欄不足の場合はコピーの上、使用してください。"]
[null,"[保険料]　　５００円　　×　  　人　　　＝　         　円　(大会参加費とともに別で支払い)"]
[null,"※メール送信先　　＜保険代理店＞：　nobum@knz-muramoto.ecnet.jp　　　　　　　　　　　　　　　　　　　　　　　　　　　\n送信先：　　株式会社金沢ムラモト　　担当　　　村本　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
[]
[]
[null,"※問合せ先：損害保険ジャパン株式会社（取扱代理店　(株)金沢ムラモト）　担当：村本）　　　\n  　　　　　　　ＴＥＬ：076－246－0123　　　ＦＡＸ：076－246－0220"]