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[]
["公益信託澁澤民族学振興基金　国際研究集会参加旅費助成申請書"]
[]
[]
["この申請書および添付した資料に記載されている事項は、助成金の支給対象選考等、当公益信託の運営に必要な範囲内で、当基金の 運営委員・信託管理人が取得･利用すること、また、支給が決定した場合は、氏名・所属等の情報が主務官庁へ提供される他、一般に公開されることについて、同意のうえ応募します。"]
[]
[]
["記載日　　　　　年　　月　　日　　　　　　　　　　　"]
["（ふりがな）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印",null,null,"生年月日"]
["氏　名"]
[]
[]
["所属・職名"]
[]
[]
["現住所",null,null,"〒-",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話"]
[]
[]
["連絡先",null,null,"〒-",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話"]
[]
[]
["e-mail"]
["アドレス"]
[]
["海外から招へいの場合は、実際の旅行者について記載してください。"]
["氏名"]
["所属・職名"]
["現住所",null,null,"〒-\n",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話",null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
["e-mail"]
["参加予定の研修集会"]
["集会\n主催団体名"]

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["開催日",null,null,"～"]
["開催地"]
["旅行予定日","出発予定日",null,"泊　　日  (うち機中　　泊)"]
[null,"帰国予定日"]
["航空運賃\n予定額",null,null,"宿泊費\n予定額"]
["助成\n希望額",null,null,"（上限200,000円）"]
["発表予定\n題目"]
["派遣・招聘の意義"]
["（集会の性格やその中での研究発表の役割、学会への貢献などに関して、日本語にてお書きください。（500字以内で枠内に））"]
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