ロミオ×ジュリエット　プレゼントキャンペーン　第一弾

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ロミオ×ジュリエット　プレゼントキャンペーン　第一弾

下記項目にご記入の上ご応募ください。★印は必須項目です。

★氏名
★ふりがな
★郵便番号	〒 - (半角)
★住所	※市・町・村・郡・ビル名まで入力してください。
★電話番号	(例：0312345678)
★Ｅｍａｉｌ	(例：abc@abcde.co.jp)
★性別	男性　女性
★年代

今回ご記入いただいた内容はマーケティング及び賞品の発送に利用させていただきます。

※当選者の発表は賞品の発送をもってかえさせていただきます。

個人情報について