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["日本診療情報管理士会 入会申込書"]
[]
["①下記事項をすべてご記入のうえ、メール添付 (info.jhima@kanrishikai.jp) 、 FAX （03-3221-9892）または郵送にて"]
["　　事務局までお申し込みください。"]
["②入会金（3,000円⇒無料）・初年度年会費（7,000円⇒無料）新規入会者に限り(※会計年度：4月1日～翌年3月31日)"]
["● ［　］内はいずれかにチェック☑してください。",null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日"]
["　貴会の趣旨に賛同し、[ 　　　　 　　　　　 ]　として入会いたします。"]
["フリガナ",null,null,null,null,null,null,null,"性別","生年月日"]
["氏　 名　",null,null,null,null,null,null,null,null,null,"年",null,"月",null,"日生"]
["勤務先　",null,null,"（※正式名称をご記入下さい）",null,null,null,null,"所属"]
[]
[null,null,null,null,null,null,null,null,"役職"]
["　勤務先住所 ",null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,"（ビル・マンション名、部屋番号も記入してください）"]
[null,null,"↓都道府県を選んでください"]
[]
[]
[]
["　勤務先 TEL ",null,"　  　　　　　　　　　",null,null,null,null,null,"内線　（",null,null,"）"]
["　自宅住所 ",null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,"（ビル・マンション名、部屋番号も記入してください）"]
[null,null,"↓都道府県を選んでください"]
[]
[]
[]
["  連絡先 TEL　　",null,null,"自宅：",null,null,null,null,"携帯："]
[" 郵送物送付先　",null,"[ ",null,null,null," ]　に送付"]
["  Ｅメールアドレス",null,null,null,null,null,null,null,null,"[ ",null,null,null,null,null,"]"]
["現職種について",null,null,null,null,null,"認定番号"]
[null,null,null,null,null,null,null,"（認定年：西暦　 　 　　年、　診療情報管理士勤務年数：　　　 　年）"]
[]
[]
[]
[]
[]
["記入者連絡欄"]
[]
[]
["お振り込み"]
["１０，０００円（入会金３,０００円・年会費７,０００円）※新規入会者に限りお振込みは不要です"]
[]
[" 【振込口座】",null,null,null,null,null,null,null,"【郵便局からの場合】"]
[]
["　　　銀行名： ゆうちょ銀行（金融機関コード　9900）"]
["　　　店　番：  019　      　 店　名： 〇一九店(ゼロイチキュウ店)",null,null,null,null,null,null,null,"　　　　　口座番号： 00180-8-446978"]
["　　　預金種類： 当座    　口座番号： 0446978",null,null,null,null,null,null,null,"　　　　　口座名： 日本診療情報管理士会"]
["　　　受取人名： ニホンシンリヨウジヨウホウカンリシカイ"]
[]
[]
[null,null,null,null,null,null,"【事務局連絡事項】"]
[null,null,null,null,null,null,"※ご記入いただきました個人情報は、以下の利用目的に限り使用いたします。"]
[null,null,null,null,null,null,"・会員管理、お問合せ等への対応、会誌・書籍等の発送、研修会等のご案内"]
[null,null,null,null,null,null,"・一般社団法人日本病院会 診療情報管理士通信教育事業への協力"]
[null,null,null,null,null,null,"・本会の充実、改善のために行う調査・研究事業（アンケートの送付等）"]
[]
["【申込先・お問い合わせ先】",null,null,null,null,null,null,null,null,"事務局使用欄"]
["　日本診療情報管理士会　事務局",null,null,null,null,null,null,null,null,"会員番号",null,null,"入会受付日"]
["　〒102-8414　東京都千代田区三番町9-15"]
["　ホスピタルプラザビル　一般社団法人日本病院会内"]
["　　URL ： https://www.kanrishikai.jp/　"]

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[null,"会員種別","性別","年","月","日","都道府県（勤務先）","都道府県（自宅）"]
[null,"正会員","男",1955,1,1,"北海道","北海道"]
[null,"賛助会員","女",1956,2,2,"青森県","青森県"]
[null,null,"他",1957,3,3,"岩手県","岩手県"]
[null,null,null,1958,4,4,"宮城県","宮城県"]
[null,null,null,1959,5,5,"秋田県","秋田県"]
[null,null,null,1960,6,6,"山形県","山形県"]
[null,null,null,1961,7,7,"福島県","福島県"]
[null,null,null,1962,8,8,"茨城県","茨城県"]
[null,null,null,1963,9,9,"栃木県","栃木県"]
[null,null,null,1964,10,10,"群馬県","群馬県"]
[null,null,null,1965,11,11,"埼玉県","埼玉県"]
[null,null,null,1966,12,12,"千葉県","千葉県"]
[null,null,null,1967,null,13,"東京都","東京都"]
[null,null,null,1968,null,14,"神奈川県","神奈川県"]
[null,null,null,1969,null,15,"新潟県","新潟県"]
[null,null,null,1970,null,16,"富山県","富山県"]
[null,null,null,1971,null,17,"石川県","石川県"]
[null,null,null,1972,null,18,"福井県","福井県"]
[null,null,null,1973,null,19,"山梨県","山梨県"]
[null,null,null,1974,null,20,"長野県","長野県"]
[null,null,null,1975,null,21,"岐阜県","岐阜県"]
[null,null,null,1976,null,22,"静岡県","静岡県"]
[null,null,null,1977,null,23,"愛知県","愛知県"]
[null,null,null,1978,null,24,"三重県","三重県"]
[null,null,null,1979,null,25,"滋賀県","滋賀県"]
[null,null,null,1980,null,26,"京都府","京都府"]
[null,null,null,1981,null,27,"大阪府","大阪府"]
[null,null,null,1982,null,28,"兵庫県","兵庫県"]
[null,null,null,1983,null,29,"奈良県","奈良県"]
[null,null,null,1984,null,30,"和歌山県","和歌山県"]
[null,null,null,1985,null,31,"鳥取県","鳥取県"]
[null,null,null,1986,null,null,"島根県","島根県"]
[null,null,null,1987,null,null,"岡山県","岡山県"]
[null,null,null,1988,null,null,"広島県","広島県"]
[null,null,null,1989,null,null,"山口県","山口県"]
[null,null,null,1990,null,null,"徳島県","徳島県"]
[null,null,null,1991,null,null,"香川県","香川県"]
[null,null,null,1992,null,null,"愛媛県","愛媛県"]
[null,null,null,1993,null,null,"高知県","高知県"]
[null,null,null,1994,null,null,"福岡県","福岡県"]
[null,null,null,1995,null,null,"佐賀県","佐賀県"]
[null,null,null,1996,null,null,"長崎県","長崎県"]
[null,null,null,1997,null,null,"熊本県","熊本県"]
[null,null,null,1998,null,null,"大分県","大分県"]
[null,null,null,1999,null,null,"宮崎県","宮崎県"]
[null,null,null,2000,null,null,"鹿児島県","鹿児島県"]
[null,null,null,2001,null,null,"沖縄県","沖縄県"]
[null,null,null,2002]
[null,null,null,2003]
[null,null,null,2004]
[null,null,null,2005]
[null,null,null,2006]
[null,null,null,2007]
[null,null,null,2008]
[null,null,null,2009]
[null,null,null,2010]
[null,null,null,2011]
[null,null,null,2012]
[null,null,null,2013]
[null,null,null,2014]
[null,null,null,2015]
[null,null,null,2016]
[null,null,null,2017]
[null,null,null,2018]
[null,null,null,2019]