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[null,"富山県レスリング協会  殿"]
[]
[null,"第76回三重国体　出場資格実態調査票"]
[]
[null,"競技名","レスリング競技",null,null,"記載者氏名"]
[null,"生年月日","　　　　　　　年　　　　　　月　　　　　　日",null,null,"年齢",null,"歳",null,null,"＊生年月日は、西暦で記入願います。"]
[]
[]
[null,"1.第76回国民体育大会（三重県）について参加を希望しますか？"]
[{"$nulls":7},"はい",null,"いいえ"]
[{"$nulls":10},"＊どちらかを〇で囲んで下さい。"]
[]
[null,"2.日本レスリング協会登録状況　調査票"]
[]
[null,null,null,"日本レスリング協会登録"]
[null,null,null,"登　録",null,"済","未"]
[null,null,null,"段　位",null,"段",{"$nulls":4},"＊国体出場には、３段取得が必要です。"]
[null,null,null,"番　号",null,"№"]
[]
[null,"3.これまでのレスリング競技の成績表（各自把握している範囲で出場大会名と成績を記入　例．優勝、準優勝、3位、ベスト4、ベスト8　など記入）"]