REQUEST & MAIL

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value="575">Moonlight Lovers</option> <option value="240">沈黙の金曜日</option> <option value="343">相沢梨紗（でんぱ組.inc）のラジオ活動</option> <option value="539">Radio have Fun</option> <option value="541">ミームトーキョーのナウいヤングラジオ</option> <option value="588">Betyの『べ』しゃり場！！</option> <option value="525">Devil ANTHEM.の「でびラジ」</option> <option value="567">Peel the AppleのGirly Time！</option> <option value="384">上月せれなのラジオモンスター</option> <option value="596">秋本帆華のウルトラGT</option> <option value="585">アップアップガールズ（２）二の足Talking</option> <option value="532">Music Spice！（Appare!）</option> <option value="582">Music Spice！（MyDearDarlin’）</option> <option value="617">Music Spice！（Rons week）</option> <option value="609">Music Spice！（犬塚ヒカリ）</option> <option value="603">ルルネージュの寝ルネージュ</option> <option value="442">halcaの「キミの隣」</option> <option value="590">オレたち！あほんだラジオ！！</option> <option value="612">AKB48のUP-Tension</option> <option value="615">chuLaのちゅらいでーないと</option> <option value="274">WADA CAFÉ</option> <option 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placeholder="アーティスト" value=""> </div> <div class="columns small-12 medium-6"> <label>あなたのラジオネーム</label> <input type="text" id="radioname" name="radioname" placeholder="あなたのラジオネーム" value=""> </div> <div class="columns small-12 medium-6"> <label class="label-req">氏　名</label> <div class="row"> <div class="columns small-6"> <input type="text" id="namelast" name="namelast" placeholder="姓" value="" required> <span class="form-error">苗字をご入力ください。</span> </div> <div class="columns small-6"> <input type="text" id="namefirst" name="namefirst" placeholder="名" value="" required> <span class="form-error">お名前をご入力ください。</span> </div> </div> </div> <style type="text/css">.iblock em{display: inline-block;}.iblock em span.is-visible{display: inline-block!important ;}.iblock em input{margin: 0 0 0 0;}</style> <div class="columns small-12 medium-6"> <div class="row"> <div class="columns small-7"> <label class="label-req">性別</label> <fieldset class="iblock"> <em><input type="radio" name="sex" value="m" id="men" required><label for="men">男性</label></em> <em><input type="radio" name="sex" value="w" id="women"><label for="women">女性</label></em> <em><input type="radio" name="sex" value="o" id="other"><label for="other">その他</label></em> <em><input type="radio" name="sex" value="d" id="dna"><label for="dna">回答しない</label><span class="form-error">性別をお選びください。</span></em> </fieldset> </div> <div class="columns small-5"> <label class="label-req">年齢</label> <input type="text" id="age" name="age" placeholder="年齢" value="" required> <span class="form-error">年齢をご入力ください。</span> </div> </div> </div> <div class="columns small-12 medium-6"> <div class="row"> <div class="columns small-6 zip-box"> <label>〒郵便番号</label> <input type="text" id="zip" name="zip" value=""> </div> <div class="columns small-6"> <label>都道府県</label> <fieldset> <select id="pref" name="pref" tabindex="5"> <option value="">都道府県をご選択ください</option> <option value="1">北海道</option> <option value="2">青森県</option> <option value="3">岩手県</option> <option value="4">宮城県</option> <option value="5">秋田県</option> <option value="6">山形県</option> <option value="7">福島県</option> <option value="8">茨城県</option> <option value="9">栃木県</option> <option value="10">群馬県</option> <option value="11">埼玉県</option> <option value="12">千葉県</option> <option value="13">東京都</option> <option value="14">神奈川県</option> <option value="15">新潟県</option> <option value="16">富山県</option> <option value="17">石川県</option> <option value="18">福井県</option> <option value="19">山梨県</option> <option value="20">長野県</option> <option value="21">岐阜県</option> <option value="22">静岡県</option> <option value="23">愛知県</option> <option value="24">三重県</option> <option value="25">滋賀県</option> <option value="26">京都府</option> <option value="27">大阪府</option> <option value="28">兵庫県</option> <option value="29">奈良県</option> <option value="30">和歌山県</option> <option value="31">鳥取県</option> <option value="32">島根県</option> <option value="33">岡山県</option> <option value="34">広島県</option> <option value="35">山口県</option> <option value="36">徳島県</option> <option value="37">香川県</option> <option value="38">愛媛県</option> <option value="39">高知県</option> <option value="40">福岡県</option> <option value="41">佐賀県</option> <option value="42">長崎県</option> <option value="43">熊本県</option> <option value="44">大分県</option> <option value="45">宮崎県</option> <option value="46">鹿児島県</option> <option value="47">沖縄県</option> </select> </fieldset> </div> </div> </div> <div class="columns small-12"> <label>郡市区町名・番地・建物名及び部屋番号</label> <input type="text" id="address" name="address" placeholder="郡市区町名・番地・建物名及び部屋番号" value=""> </div> <div class="columns small-12 medium-6"> <label>電話番号</label> <input type="text" id="tel" name="tel" placeholder="電話番号" value=""> </div> <div class="columns small-12 medium-6"> <label>メールアドレス</label> <input type="email" id="mail" name="mail" placeholder="メールアドレス" pattern="email" value=""> </div> <div class="columns small-12 medium-8"> <div> 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