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["ＭＣＴＶ自主放送番組参加申込書"]
[]
[null,"三沢市商工会 御中",{"$nulls":4},"平成　　 　年　 　　月　　 　日"]
[]
[null,"　私は、三沢市ケーブルテレビジョンの行なう自主制作番組「　　　　　　　　　　　　　」に\n出演をしたいので、三沢市商工会からの御推薦をお願いいたします。"]
[]
[]
[null,"■申込社記入欄"]
[null,"事業者名"]
[]
[null,"代表者名",null,"㊞　　　　"]
[]
[null,"生年月日",null,"大正・昭和・平成　　　　年　　　月　　　日　　（　　　　才）"]
[null,"事 業 所",null,"〒□□□－□□□□\n所在地"]
[]
[]
[null,null,null,"TEL　　　　　　（　　　）　　　　　　　　FAX　　　　　　　（　　　）"]
[null,"資 本 金",null,"万円　　　",null,null,"従業員数","名　　　"]
[null,"事業内容",{"$nulls":5},"商工会\n加　盟","有・無"]
[]
[null,"告知等の概要"]
[]
[]
[null,"※ご記入いただいた内容につきましては、三沢市商工会及び三沢市において保有・管理し、当広告事業の運営に関してのみ利用します。"]
[]
[]
[]
[null,null,null,"自主放送番組出演推薦状"]
[]
[null,"三沢市長　　種市　一正 殿"]
[]
[null,"三沢市商工会は三沢市ケーブルテレビジョンの番組に上記事業者を推薦いたします。"]
[]
[{"$nulls":4},"平成　　　　年　　　　月　　　　日"]
[]
[{"$nulls":5},"三 沢 市 商 工 会"]
[{"$nulls":5},"会　長　竹　林　秋　雄　　　印"]
[]
[]
[null,"（注）","１．三沢市商工会会長印なき証明書は無効です。"]
[null,null,"２．訂正印なき訂正は無効です。"]

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