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[{"$nulls":8},"様式　　１"]
[null,"生物生産学部緑翠会学生学会発表援助事業申請書"]
[]
[{"$nulls":4},"　　　　　　　　　　申請年月日：令和　　　年　　　月　　　日"]
[]
[null,"ふりがな",{"$nulls":5},"性別","男・女"]
[null,"申請者氏名・印",{"$nulls":4},"　　　印"]
[{"$nulls":7},"□学部"]
[null,"所属",{"$nulls":5},"□修士"]
[{"$nulls":7},"□博士"]
[null,"連絡先","E-mail",{"$nulls":3},"電話"]
[]
[null,"発表学会名"]
[]
[null,null,"令和　　年　　　月　　　日　～　年　　月　　日"]
[null,"発表日時",{"$nulls":4},"開催地"]
[]
[null,"発表題目",{"$nulls":5},"発表形態","□　口頭"]
[{"$nulls":8},"□　ポスター"]
[]
[null,"発表者（すべて）（発表者の前に○をつけて下さい）"]
[]
[]
[null,"指導教員　　　氏名・印",{"$nulls":5},"印"]
[]
[null,"受付年月日　　","令和　　　年　　　　月　　　　　日"]
[null,"援助受領　　　　年月日　　　","令和　　　年　　　　月　　　　　日　　",{"$nulls":3},"受領　　　　　氏名・印",null,"　　　　　　　　印"]
[null,"太枠内は申請時に記入しないこと。援助金受領の際に印鑑を持参すること。"]
[null,"該当欄は，チェック又は■。申請時に，学会のプログラム等を添付すること。"]