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Pre-registration Page for the Gift book "Our Precious Child"
Please fill out the form below and send it to us. For gift application, please use the other form.
Please choose the maternity clinic of your birth plan.
必須required
Hokkaido: Teine Keijinkai Hospital.
Hokkaido: Sapporo Mirai Clinic.
Hokkaido: Ena Ladies Clinic
Tochigi-Ken: Yume Clinic
Ibaraki-ken: Nanairo Ladies Clinic
Ibaraki-ken: Kase Hospital
Saitama-ken: Samejima Bonding Clinic
Saitama-ken: SSato Sanhujinka
Tokyo-to: Sakuradai Maternity Clinic
Sample: Anzan Maternity Clinic
Mother's First name and Surname
必須required
Furigana
e-mail address
必須required
確認用
Telephone number
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Expected birth date
必須required
西暦
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Questions
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