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Full name:

Example: Taro Yamada

 

Name of work / school:

Example: Sakura Hospital

 

Department:

Example: Pathology

 

Phone:

Example: 0312345678

 

States:

Example: Tokyo

 

Email:

 

Contents of inquiry:

 

Regarding inquiries, the person in charge will contact you with the answer. Please note that we may not be able to respond depending on the content. The information you enter will not be used for any purpose other than our guidance.