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■Your name
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■E-mail address
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■Who wants to take the lesson?
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■How old are you?
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■Where are you from?
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■What languages do you speak?
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■What do you think of your current Japanese level?
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■Which place would you to take lessons?
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■What kind of Japanese skills do you want to improve?
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■Is there anything you want to tell me?
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■Would you like to take a trial lesson/consultation(Free)?
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