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["行 政 視 察 申 込 書"]
["送付先：田原市議会事務局"]
["E-mail：gikai@city.tahara.aichi.jp"]
["F A X ：0531－22－5952",null,null,null,null,null,null,null,null,null,null,"申込日：令和　年　　月　　日（　　）"]
["視察希望日時",null,"第1希望","令和　　年　　月　　日（　　）　　　：　　　～　　　："]
[null,null,"第2希望","令和　　年　　月　　日（　　）　　　：　　　～　　　：",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"都"]
["団体名",null,null,null,null,null,null,"県",null,null,null,null,null,"議会",null,null,null,null,null,null,null,null,"道"]
["委員会名・会派名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"府"]
["視察人員",null,"議員　　　　　　　　名",null,null,null,"その他（　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"県"]
[null,null,"事務局　　　　　　　名",null,null,null,"執行部　　　　　　　　名",null,null,null,null,"合計　　　　　　名"]
["視察内容\n(具体的にご記入ください)",null,"テーマ"]
[null,null,"調査\n事項\n・\n選定\n理由等"]
[]
["現地視察希望",null,"有（　　　　　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,"無"]
["担当者",null," 所 属 ："]
[null,null," 氏 名 ：",null,null,null,null,"様",null,"ＴＥＬ："]
[null,null," E-mail：",null,null,null,null,null,null,"ＦＡＸ："]
["交通手段",null,"　公共交通機関（　　　時　　　分着）",null,null,null,null,null,null,null,null,"公用車等"]
["市内宿泊",null,"　 有（宿泊先：　　　  　     　　　　　　）",null,null,null,null,null,null,null,null,"未定",null,null,"無"]
["市内飲食",null,"　 有（飲食先：　　　       　　　　　　　）",null,null,null,null,null,null,null,null,"未定",null,null,"無"]
["特記事項"]
[]
["※以下、田原市議会事務局記入欄"]
["受入日時"," 令和　年　　月　　日（　　）",null,null,null,null,"受入回答日",null,null," 令和　年　　月　　日（　　）"]
["受け入れ"," 可　・　不可（理由：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 　）"]
["担 当 課"]
["会    場"]
["備    品"," プロジェクター　　ＰＣ　　その他（　　　　　　　　　　　　　　　　　　　　　　　　  ）"]
["配付資料"," 議会概要  市勢ミニ要覧  各パンフレット  説明資料   その他（　　　　　　　　　　　   ）"]
["出 席 者","議  会","　　議長"," 委員長（　　　　　　）",null,null,null,null,"局長","　　 （　　　　　　　　　　　  ）"]
[null,"執行部"]
["送　　迎","　　 有（　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　）",null,null,null,null,null,null,null,null,null,null,null,null,"無"]
["そ の 他"]