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Application form ([heart breathing] commuter pass sightseeing bus taxi day return plan)

[heart breathing] Chartered sightseeing taxi day return plan

Plan name ※required
Representative full name ※required
Furigana ※required
The date of birth ※required
/ /   
Sex ※required
Phone number ※required
(Half-width number)

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


※As an email does not arrive when an address is not input definitely, please be careful.

※When I perform domain designation by the measures of the junk email, I may not receive an email. You receive "@kyusho-tour@kyusho.co.jp", and please set it.
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 (the first hope) ※required

※I take it off than a choice on a day impossible of a reservation.
※Please note that you may not take it depending on the space situation in the days when you had you choose him either.
The departure date (the second hope)
Optional tour ※required
Confirmation ※required
※Please note that a customer except citizens of Nagasaki becomes inapplicable to the discount.
In the second hometown about the entry to the discount application of the trip campaign of "heart breathing" ※required
This tour becomes the amount of money that I receive the furtherance and discounted from Nagasaki.
As when a reservation is completed, and send a reservation confirmation, send the left note application; the phone number (if there are any landlines with a landline.every the address ③ address of all ① participant name ② participants When there is not it, after filling out cell-phone number), I would like return.
Change, additional staying of the return journey surface mail
Please input about companion.
Companion 1: Full name ※required
Companion 1: Furigana ※required
Companion 1 a phone number (in the case of the address where is different from representative, please input):
Companion 1 an address (in the case of the address where is different from representative, please input):
 
Companion 1: The date of birth ※required
/ /   
Companion 1: Sex ※required
Companion 2: Full name
Companion 2: Furigana
Companion 2 a phone number (in the case of the address where is different from representative, please input):
Companion 2 an address (in the case of the address where is different from representative, please input):
 
Companion 2: The date of birth
/ /   
Companion 2: Sex
Companion 3: Full name
Companion 3: Furigana
Companion 3 a phone number (in the case of the address where is different from representative, please input):
Companion 3 an address (in the case of the address where is different from representative, please input):
 
Companion 3: The date of birth
/ /   
Companion 3: Sex
Companion 4: Full name
Companion 4: Furigana
Companion 4 a phone number (in the case of the address where is different from representative, please input):
Companion 4 an address (in the case of the address where is different from representative, please input):
 
Companion 4: The date of birth
/ /   
Companion 4: Sex
Companion 5: Full name
Companion 5: Furigana
Companion 5 a phone number (in the case of the address where is different from representative, please input):
Companion 5 an address (in the case of the address where is different from representative, please input):
 
Companion 5: The date of birth
/ /   
Companion 5: Sex
When a column is not enough, please fill out the following remarks column.
Companion
Text box
Kyushu Syosen
〒850-0035
16-12, Motofunamachi, Nagasaki-shi, Nagasaki
TEL.0570-017510
1.Passenger regular line business
2.Harbor express service business
3.Car transport
4.Travel agency
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