Reception form ホームページ掲載の可否 ※ご協賛頂いた方のお名前をホームページ上に掲載致します。 掲載を希望されない場合はチェックを入れてください。 ホームページの掲載を希望しない nameRequired Example: Taro Yamada PhoneticRequired Example) Yamada Taro Postal codeRequired 〒 - Prefecturalrequired Example) Tokyo Please select from the following Hokkaido Aomori Prefecture Iwate Prefecture Miyagi Prefecture Akita Yamagata Prefecture Fukushima Prefecture Ibaraki Prefecture Tochigi Prefecture Gunma Prefecture Saitama Chiba Tokyo Kanagawa Prefecture Niigata Prefecture Toyama Prefecture Ishikawa Prefecture Fukui prefecture Yamanashi Prefecture Nagano Prefecture Gifu Prefecture Shizuoka Prefecture Aichi prefecture Mie Prefecture Shiga Prefecture Kyoto Osaka Hyogo prefecture Nara Prefecture Wakayama Prefecture Tottori prefecture Shimane Prefecture Okayama Prefecture Hiroshima Prefecture Yamaguchi Prefecture Tokushima Prefecture Kagawa Prefecture Ehime Prefecture Kochi Prefecture Fukuoka Prefecture Saga Prefecture Nagasaki Prefecture Kumamoto Prefecture Oita Prefecture Miyazaki prefecture Kagoshima prefecture Okinawa Prefecture Addressrequired Example) 2-3-1, Asakusa, Taito-ku mail addressRequired Example) test@asakusajinja.jp Email address (for confirmation)required Example) test@asakusajinja.jp phone numberRequired Example) 03-0000-1111 - - Payment methodRequired ※ Please choose either Bring payment Bank transfer Amount (mouth)Required * 10,000 yen per unit, 3 or more units can be named on the sponsor nameplate Example 1 Amount (yen)Required * Please enter only the numbers. Example) 10000 Name insertion (Those who wish 3 or more in amount) ※ Please enter the person who wants to put in a name. Approximately 10 characters Remarks Those who do not need shipment etc. Please check the person who does not need a thank you letter, mailing etc from our company. No need for thank-you letters, mailings, etc.