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夢を叶える塾|入会・無料体験申し込み

入会・無料体験申し込み

ご入会と無料体験のお申込み専用の入力フォームになります。
また、翌年度から中学生に進学される方の予約についても本フォームにて承っております。

お申込みにあたり

まず本入力フォームでお申込み頂きましても、お申し込みとはなりませんのでご安心・ご留意ください。
頂いた内容をもとにご連絡させていただきまして、その後のお申込みとなります。
送信ボタンを押して頂けますと、入力内容をチェック後に問題なければ確認の自動メールが送信されますのでご確認ください。
届いていない場合は申し訳ございませんがお申込みに失敗している可能性がございますので、再度送信頂けますようよろしくお願いいたします。
※一部hotmail等のメールアドレスで確認の自動メールを受信できない可能性がございます
※返信メールが迷惑メールフォルダに入る可能性もございますので迷惑メールフォルダを念のためご確認ください
※頂いたお申込みには折り返しに指定頂いた返信先にご連絡させて頂いております。
※不確実性もありますのでお電話が可能であればお電話頂けますと確実です。
お電話:0238-27-0566

入力内容について

ご連絡のため、お申込者様氏名、生徒様氏名、確認用のメールの送信先、お電話番号、折り返し用の連絡先、入会前面談のご希望、お申込み内容については必ずご入力ください。
※メールでのご連絡が届かない方もおられますため、お電話番号を必須項目とさせていただきます。
その他の項目は特に必須ではございませんが、入力いただけましたら幸いです。
特筆すべき事項がございましたらフリーテキスト欄にて教えてください。
頂いた情報は、お申込みのためのご連絡先として、また、お申込み内容の確認のためにのみ利用させていただきます。
※個人情報として大切に扱い、不要な営業等も致しませんのでご安心ください

入会・無料体験申し込みフォーム

お申込者様ご氏名 (必須)

メールアドレス (必須)

生徒様ご氏名 (必須)

生徒様の学年
小学生中学1年生中学2年生中学3年生
高校1年生高校2年生高校3年生その他

ご住所

お電話番号(必須)

※折り返しのご連絡先に連絡後お返事頂けない場合等にお電話させて頂く場合がございます。

折り返しのご連絡先(必須)
メール郵送電話その他

入会前面談のご希望(必須)
希望する希望しない

お申込み内容 (必須)
ご入会無料体験中学1年生の予約その他

気になっている授業
数学実演特別授業フリー/自習相互支援会その他

通塾の目的
学校補習受験数学自習室その他

フリーテキスト

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