Form transmission of reservation
*=(indispensable input) #=(Either is indispensable.)
Hope day
*
day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
month
Jan1
Feb2
Mar3
Apr4
May5
Jun6
Jul7
Aug8
Sep9
Oct10
Nov11
Dec12
year
2011
2012
Number of people
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Number of classes
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Hope time
*
hour
6
7
8
9
10
11
12
13
14
15
16
17
|
min.
*
0
10
20
30
40
50
Representative name
*
Sex
Male
Female
zip-code
*
-
Country
*
prefecture
*
Address
*
Telephone number
#
Cellular phone
#
Facsimile number
Mail Address
*
Mail address reinput
*
Please give me reinput for a check.
Communication column
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