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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"寄　付　申　込　書"]
[]
["学校法人 園田学園",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"（申込日）",null,null,null,"　　年　　　月　　　日"]
[null,"理事長 齊藤　悦一　殿"]
[]
["学校法人 園田学園の教育研究方針に賛同し、下記のとおり寄付を申し込みます。"]
[]
["寄付申込者","法人名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"印"]
[]
[null,"代表者役職\nご芳名"]
[]
[null,"所在地",null,null,null,null,null,null,null,"〒",null,null,null,null,null,null,"－"]
[]
["ご連絡担当者",null,null,null,null,null,null,null,"部署名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"役職名",null,null,null,null,null,null,null,"ご芳名"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(ﾌﾘｶﾞﾅ）"]
[]
[null,null,null,null,null,null,null,null,"連絡先",null,null,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,"E-mail"]
[]
["寄付金額",null,null,null,null,null,null,null,null,null,null,null,null,"金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
["振込予定日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,null,"月　　　　　",null,null,null,"日"]
["振込先・口座\n〔□にチェック✓〕",null,null,null,null,null,null,null,null,null,null,null,"三井住友銀行　　　伊丹支店　　　普通　　　口座番号：0454237"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"みなと銀行　　　　塚口支店　　　普通　　　口座番号：1502250"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"みずほ銀行　　　　塚口支店　　　普通　　　口座番号：1895752"]
[]
[]
[]
[null,null,null,null,null,null,null,null,"（口座名義）　学校法人　園田学園　理事長　齊藤　悦一"]
["寄付先部門\n〔□にチェック✓〕",null,null,null,null,null,null,null,null,null,null,null,"大学　　　",null,null,null,null,null,null,null,null,null,"短期大学部",null,null,null,null,null,null,null,null,"高等学校",null,null,null,null,null," 中学校"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"園田学園幼稚園",null,null,null,null,null,null,null,null,null,"学が丘幼稚園",null,null,null,null,null,null,null,null,"学園全体"]
[]
[]
[]
["寄付金の使途\n〔□にチェック✓〕",null,null,null,null,null,null,null,null,null,null,null,"使途の指定はしない（教育研究に係る経常経費や施設設備の充実費全般）"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"使途の指定をする"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"奨学金充実事業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,"課外活動支援事業",null,null,null,null,null,null,null,null,null,null,"円"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"学園運営支援事業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,"キャンパス整備事業",null,null,null,null,null,null,null,null,null,null,"円"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"　※ご指定の使途へ寄付額をご記入ください。"]
[]
[]
[]
["寄付金の種類\n〔□にチェック✓〕"]
[null,null,null,null,null,null,null,null,null,null,null,null,"受配者指定寄付金　　※本書のほか「様式1-1」をご提出ください。"]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"特定公益増進法人に対する寄附金"]
[]
[]
[]
[]
["御社の決算期日",null,null,null,null,null,null,null,null,null,null,null,null,null,"月",null,null,null,"日",null,null,"【注】受配者指定寄付金の受領書日付は本学への入金日ではなく、本学から私立学校振興・共済事業団への寄付金転送日となります。なお、転送にはご入金日から2～3週間程度要します。"]
[]
["ご芳名を本学のホームページ等に掲載させていただきます。希望されない場合は□にチェック✓をつけてください。"]
[]
[null,null,null,null,null,null,"記載を希望しない"]
[]
[]
[]
[]
["応援メッセージがございましたらご記入ください。"]
[]
["※ 領収書の「領収者名」は、ご記入いただきました寄付申込者名となります。"]
["※ ご記入いただきました個人情報は、寄付金募集に係る業務のみに使用いたします。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　※　受付"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"学校法人 園田学園　事務管理部"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〒661-8520 　尼崎市南塚口町7-29-1"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"TEL：06-6429-9645　FAX：06-6422-8523"]