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THE 6OTH INTERNATIONAL SPEECH CONTEST IN JAPANESEAPPLICATION FORM

NO.

1

It Family Name & Given Name Middle Name ++r,\ Mr. ,/ Ms.

E& tr*ENationality

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3cm x4cmlJt'("4.5 cm x 4.5 cno)t+l:1&.1 zr .l i l:Hfif+L C< ra'Sr,,

Fr.rll Name(in Roman

letters as inyour passport)

2 +.TFF EDate of Birth +

(year)E B+.

(month) (day)2079rF6Et flq#.D+ffi ffi

(age, as ofJune 1, 2019)

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Addressin Japan

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5

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rfrHSpeech Title

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Employmentfira+PiEducation

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(dav)i;,r':,r,Ili litr)i,),,1r' j-. 1t:,/) \"1.,il,,t l:,l-I ht'r't'hv ill{rct to tht't'rrtttiitiolrs st,t firrth ir-r this btrllt,tin ol'inlor.n)irtion;rnrl;rllirru thirtI ittlt thr'Pt'rsott rvhosc ttrltnc rull aritlrt,ss;rre givert on this;rpplrr.irtiol lirytrr.

llri4 Fi'd" '/, Signature of Applicant

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btt;f:tlfiA*Tfilitf.$f::&,irt>u)*:fft"b>zoWbtt'*t'v2L(</j31"'(Have y<-ru studied fbrmall5' in Japan? If yes' which category? I'lease check' )

}tl,#ttt n++tt nffi++ti n'(+ A)<+U;t JA4Arn+& 1+D|fi.

frrtrf-r,r+l'l ttJ, +;il"+74$tritrf,,, (name of institution where vou studied Japanese) ,Ul Hl (period)

lbry AA;E+;''S]IA Efrth L /: : t i\ b 0 *tr- h'"(Have you participated in other international speech contests in Japanese?)

1. tJu' (Yes)

)<ri4, (contest name) Bfl'{& E (contest date) ^'ElrD+iffi

(award received) +'fB-E{4i (sponsor)

2. Utl,ti (no)

i{: .lfio+eM\*. eft{ = )z ? -)v/sy151ffio{E Vtt'<X,*Lttz€*f<offiBI*-C'3 *il/'"(You are required to apfly the unpublished speech in other contests')

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(Please give your motive for application in Japanese')

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