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The first half of 2012 blue ize application form

Perception soft-headed Nao Teru (blue at the first half of 2024)

Plan name ※required
Representative full name ※required
Furigana ※required
The date of birth ※required
/ /   
Sex ※required
Phone number ※required

※Please input cell phone number as the emergency contact information.
E-mail address ※required


※A lot of cases which an email does not reach to an address of iCloud are confirmed. I am sorry to trouble you, but I would appreciate your registering an address except iCloud as much as possible.
※There is the possibility divided in two by ha junk email to Gmail. Please confirm it to a junk email box.
Address ※required
 
The number of participants (adult) ※required

※I become an adult from junior high student or more.
The number of participants (primary schoolchild)
The number of participants (infant)

※When a seat, a meal is unnecessary, I am free of charge.
The number of men ※required

※Please choose the number of men who are older than a primary schoolchild.
The number of women ※required

※Please choose the number of women who are older than a primary schoolchild.
The departure date (from April to June) ※required

※An exclusion day: 6/21-6/23
※I take it off than a choice on no vacancies day.
※Please note that you may not take it depending on the space situation on the selectable day either.
The departure date (from July to September) ※required

※An exclusion day: 7/20-8/31
※I take it off than a choice on no vacancies day.
※Please note that you may not take it depending on the space situation on the selectable day either.
Room type ※required
The Nagasaki Port start on a voyage time (surface mail) ※required
The Fukue Port start on a voyage time (surface mail) ※required
Dinner option ※required

※As for the Goto Italian, the ripples course becomes the meal in "a camellia teahouse" "GOTO TSUBAKI HOTEL".
※In GOTO TSUBAKI HOTEL, a 1-minute walk, the camellia teahouse are cars; about 20 minutes (belonging to pickup and drop-off)
Remarks (if there is hope of the assigning rooms, please fill it out)
※About a change, additional staying of the surface mail of the return journey
When you change the surface mail of the return journey after the third day, please fill in the date and time you like.
In addition, please fill in so when the staying after eyes is added with that in 2 nights.
Change, additional staying of the return journey surface mail
Please input to one person about the companion.
Companion 1: Full name ※required
Companion 1: Furigana ※required
Companion 1: The date of birth ※required
/ /   
Companion 1: Sex ※required
Kyushu Syosen
〒850-0035
16-12, Motofunamachi, Nagasaki-shi, Nagasaki
TEL.0570-017510
1.Passenger regular line business
2.Harbor express service
3.Transportation business
4.Travel agency
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