*1. Name (First name, Family name) 氏名required |
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*2. Gender (Mr. or Ms.) 性別(Mr.男性またはMs.女性) required |
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*3. Declaration of membership (FAA, EFDMA, AFDMA, AFDMS or other) 所属団体(学生は学校名)required |
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*4. Home address (postal code, city, street, country) 住所required |
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*5. Phone number (including country code) 電話番号required |
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*6. Professional qualifications (FDM-IC, MD, DO, PT, etc) 国家資格あるいは学生、一般required |
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*7. Clinic or Office Name 治療院名(学生は”学生”を記入してください。)required |
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*8. Email Address メールアドレスrequired |
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*9. Confirm Email Address メールアドレス確認required |
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*10. Will you join the 1st day? (Yes or No) 1日目学会(参加または不参加) required |
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*11. Will you join the 2nd day? (Yes or No) 2日目学会(参加または不参加)required |
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*12. Will you join the 3rd day? (Yes or No) 3日目セミナー(参加または不参加)required |
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*13. Will you make a presentation? (Yes, No, Not decided) 学会発表希望(あり、なし、未定)required |
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*14. Will you join the Round Trip? (Yes or No) 旅行 参加または不参加required |
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*15. Number of those joining Round Trip 旅行参加人数required |
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*16. Names and gender of Round Trip participants 旅行全参加者氏名性別 (Fill in "0" if you do not join.) (不参加は“0”を記入してください)required |
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*17. 食事 (Meals - Regular or vegetarian) required |
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*18. Arrival date and flight number (Fill in "0" if you do not join from overseas.)
(国内参加者は“0”を記入してください。) required |
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*19. Departure date and flight number (Fill in "0" if you do not join from overseas.)
(国内参加者は“0”を記入してください。) required |
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*20. The name of your hotel (Fill in "0" if you do not join from overseas.)
(国内参加者は“0”を記入してください。) required |
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Inquiry concerning the Congress 学会お問い合わせ |
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Inquiry concerning the Round Trip 旅行お問い合わせ |
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