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[]
[null,"ふるさと選手登録届・ふるさと選手制度使用申請届"]
[]
[null,null,"（予選会出場から必要です）"]
[]
["長野県体育協会  理事長      殿"]
[]
["長野県競技団体  会　長      殿"]
[]
[]
[null,null,null,null,null,"届け出日：平成  　　　年    　 月  　　  日"]
[null,null,null,null,null,"ふりがな",{"$f":"PHONETIC(G13)","v":""}]
[null,null,null,null,null,"氏名",null,null,null,"㊞"]
[null,null,"（旧姓）"]
[null,null,null,null,null,"［ 性別 ］  1．男 　　2．女   　　＊いずれかに○印"]
[null,null,null,null,null,"生年月日","１９　　　　年　（昭和・平成　　　　　年）"]
[null,null,null,null,null,null,"月　　　　　　日　"]
[null,null,null,null,null,null,null,"（西暦と年号両方記入）"]
[]
[null,"国民体育大会ふるさと選手制度により私の「ふるさと」を【長野県】として、\n第（　　　）回大会について、下記内容のとおり使用申請します。"]
[]
[]
["１．参加競技名"]
[null,null,null,"競技",null,null,"種別",null,null,"種目"]
[]
[]
["２．現住所"]
[null,"（ふりがな）",{"$f":"PHONETIC(B30)","v":""},null,null,null,null,"電話番号"]
[null," 〒    　 -"]
[null,null,null,null,null,null,null," 携帯電話番号"]
[]
[]
["３．現在の学校又は勤務等について"]
[null,"大学名等(学年）",null,"　　　　　　学年"]
[]
[null,"会社名"]
[]
[]
["４．「ふるさと」に関する確認事項"]
[]
["（1）ふるさと登録の利用",null,null,null,null,"（2）前回大会出場の所属都道府県名"]
[null,"利用回数（今回の使用含む）"]
[null,"１．初回",null,"回目",null,"          回"]
[null,"２．2回目",null,"回目"]
[null,"＊１．又は２．のいずれかに○印",null,null,null,"＊前回大会（県内予選会を含む）に出場の所属都道府県名を記載"]
[]
["（3）卒業した学校名（長野県の中学校又は高等学校）"]
[null,"（ふりがな）",{"$f":"PHONETIC(B50)","v":" "},null,null,null,null,"卒業年月日"]
[null,null,null,null,null,null,null,"Ｓ・Ｈ"]
[null," ",null,null,null,null,null,"       　年    　　月 卒業"]
[]
[null,"＊○○高校又は○○中学校など学校名を明確に記載すること。"]
[]
[null,"※参考として上記に高校を記入したら中学校名、中学を記入したら高校名を記入してください。"]
[null,"都道府県名",null,null,"学校名"]
[]
[]
["※記載された個人情報は、国体申込み（関係団体への報告）に関わることのみに使用します。"]