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["東 光 フ ァ ミ リ ー ラ イ フ ク ラ ブ"]
[]
["福  祉  移  送  サ  ー  ビ  ス"]
["Ｎ Ｐ Ｏ 法 人 な の は な 会"]
["　　　　　　　  《 入 会 申 込 書 》"]
[{"$nulls":21},"　　平成　　　　年　　　　月　　　　日"]
["　　　☆私は承認の上、ここに〔なのはな会〕の会員として入会を申し込みます"]
[]
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["住　　　　 所",null,null,null,"　〒"]
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["Ｔ　  Ｅ   　Ｌ",{"$nulls":15},"緊急連絡先",{"$nulls":7},"様","続　柄"]
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[{"$nulls":17},"明  大  昭  平",{"$nulls":4},"　　　　　年　　　月　　　日"]
[{"$nulls":17},"明  大  昭  平",{"$nulls":4},"　　　　　年　　　月　　　日"]
[{"$nulls":17},"明  大  昭  平",{"$nulls":4},"　　　　　年　　　月　　　日"]
[{"$nulls":17},"明  大  昭  平",{"$nulls":4},"　　　　　年　　　月　　　日"]
[{"$nulls":17},"明  大  昭  平",{"$nulls":4},"　　　　　年　　　月　　　日"]
["同乗者の有・無",null,null,null,"　有　・　無",{"$nulls":5},"介助の有・無",null,null,null,"　有　・　無"]
["主な利用目的地",{"$nulls":13},"使用車",null,null,"寝台車　　・　　車椅子　　・　　普通車"]
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["利用者宅周辺案内図"]
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