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["各　種　資　格　受　験　票"]
[]
["  ※記入もれのないよう正確に                                                                          ",{"$nulls":10},"  年　 　  　　月　　　  　日"]
["　※太線内のみ記入   ",{"$nulls":10},"公益社団法人 日本空手協会"]
["( フ リ ガ ナ)"]
["氏　　　　　名"]
["住　　　　　所","　〒　　　　－　　　　　　　　　　",{"$nulls":7},"　☎　　　　　　　（　　　　）"]
[null,"　　　　　　　　　都道府県　　　　　　　　　　区市郡　　　　　　　　　　　　　町村"]
[null,"　　　　　　　　　　丁目　　　　　　　　　番　　　　　　　　号　　　　　　　　　方"]
["生 年 月 日",null,"昭 和","平 成",null,null,null,"年",null,null,null,"月",null,null,null,"日",null,"( 満",{"$nulls":6},"歳 )"]
["所　　　　　属",null,null,"都 道　",{"$nulls":17},"支　部"]
[null,null,null,"府 県　",{"$nulls":17},"団　体"]
["会 員 番 号","一 般 会 員"]
[]
[null,"永 年 会 員"]
[]
["段　　　　　位",null,null,"段　　","　取得年月日",{"$nulls":12},"年",null,null,null,"月",null,null,null,"日"]
[{"$nulls":4},"段位登録番号"]
["現 有 資 格"]
[null,null,null," 級 指導員",{"$nulls":6}," 級 審査員",{"$nulls":9}," 級 審判員"]
[]
[null,"指　導　員",{"$nulls":4},"審　査　員",{"$nulls":9},"審　判　員"]
[null,"Ａ",{"$nulls":4},"Ａ",{"$nulls":9},"Ａ"]
["受 験 科 目","Ｂ",{"$nulls":4},"Ｂ",{"$nulls":9},"Ｂ"]
["( ○でかこむ )","Ｃ",{"$nulls":4},"Ｃ",{"$nulls":9},"Ｃ"]
[{"$nulls":6},"Ｄ",{"$nulls":9},"Ｄ"]
[{"$nulls":13},"審査員"]
[]
[]
["　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　審査員は合否に〇を記入"]
["判　　　　　定","合　　　　　否",{"$nulls":4},"合　　　　　否",{"$nulls":9},"合　　　　　否"]
["得　　　　　点"]
["受　　験　　料"]
["登　　録　　料"]
["備　　　　　考"]