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Inquiry about the adoption

Inquiry form

Division ※required
The name ※required
Example) Taro Yamada
Furigana ※required
Example) Yamada Taro
Sex
Age
Year
Zip code
Example) 012-3456
The metropolis and districts
Municipality
Address, name
Phone number
Example) 012-345-6789 ※A cell-phone is possible
FAX number
Example) 012-345-6789
E-mail address ※required


※I reinput it for confirmation
The type of job desired
Desired motive and appeal point / inquiry contents
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