APAC Wiley

<form id="form4791" action="https://s1133198723.t.eloqua.com/e/f2" class="elq-form" method="post" name="APAC_Form_2020_Uniday" target="_blank" > <input name="elqFormName" type="hidden" value="APAC_Form_2020_Uniday"> <input name="elqSiteId" type="hidden" value="1133198723"> <input name="elqCampaignId" type="hidden"> <div class="layout container-fluid"> <div class="row" style="padding-bottom:10px;"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement24" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div> <div class="single-checkbox-row row"> <span class="elq-required">*</span><span style="font-size: 11px; font-style:italic;"> は必須項目です</span> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement0" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe66343">敬称</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select id="fe66343" class="elq-item-select" name="salutation" style="width: 100%"> <option value="">選んでください...</option> <option value="Miss">Miss</option> <option value="Mr.">Mr.</option> <option value="Mrs.">Mrs.</option> <option value="Ms.">Ms.</option> <option value="Mx.">Mx.</option> <option value="Dr.">Dr.</option> <option value="Prof.">Prof.</option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement1" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65332">名<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65332" class="elq-item-input" name="firstName" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement2" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65333">姓<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65333" class="elq-item-input" name="lastName" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement3" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65331">メールアドレス<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65331" class="elq-item-input" name="emailAddress" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement4" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65334">携帯電話番号</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65334" class="elq-item-input" name="mobilePhone" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement5" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65356">勤務先電話番号</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65356" class="elq-item-input" name="busPhone" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement6" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65341">国<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select id="fe65341" class="elq-item-select" name="country" style="width: 100%"> <option value="">選んでください...</option> <option value="Afghanistan">Afghanistan </option> <option value="Aland Islands">Åland Islands </option> <option value="Albania">Albania </option> <option value="Algeria">Algeria </option> <option value="American Samoa">American Samoa </option> <option value="Andorra">Andorra </option> <option value="Angola">Angola </option> <option value="Anguilla">Anguilla </option> <option value="Antarctica">Antarctica </option> <option value="Antigua and Barbuda">Antigua and Barbuda </option> <option value="Argentina">Argentina </option> <option value="Armenia">Armenia </option> <option value="Aruba">Aruba </option> <option value="Australia">Australia </option> <option value="Austria">Austria </option> <option value="Azerbaijan">Azerbaijan </option> <option value="Bahamas">Bahamas </option> <option value="Bahrain">Bahrain </option> <option value="Bangladesh">Bangladesh </option> <option value="Barbados">Barbados </option> <option value="Belarus">Belarus </option> <option value="Belgium">Belgium </option> <option value="Belize">Belize </option> <option value="Benin">Benin </option> <option value="Bermuda">Bermuda </option> <option value="Bhutan">Bhutan </option> <option value="Bolivia">Bolivia (Plurinational State of) </option> <option value="Bonaire">Bonaire, Sint Eustatius and Saba </option> <option value="Bosnia and Herzegovina">Bosnia and Herzegovina </option> <option value="Botswana">Botswana </option> <option value="Bouvet Island">Bouvet Island </option> <option value="Brazil">Brazil </option> <option value="British Indian Ocean Territory">British Indian Ocean Territory </option> <option value="Brunei Darussalam">Brunei Darussalam </option> <option value="Bulgaria">Bulgaria </option> <option value="Burkina Faso">Burkina Faso </option> <option value="Burundi">Burundi </option> <option value="Cape Verde">Cabo Verde </option> <option value="Cambodia">Cambodia </option> <option value="Cameroon">Cameroon </option> <option value="Canada">Canada </option> <option value="Cayman Islands">Cayman Islands </option> <option value="Central African Republic">Central African Republic </option> <option value="Chad">Chad </option> <option value="Chile">Chile </option> <option value="People's Republic of China">China </option> <option value="Christmas Island">Christmas Island </option> <option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands </option> <option value="Colombia">Colombia </option> <option value="Comoros">Comoros </option> <option value="Congo">Congo </option> <option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the </option> <option value="Cook Islands">Cook Islands </option> <option value="Costa Rica">Costa Rica </option> <option value="Cote d'Ivoire">Côte d'Ivoire </option> <option value="Croatia">Croatia </option> <option value="Cuba">Cuba </option> <option value="Curacao">Curaçao </option> <option value="Cyprus">Cyprus </option> <option value="Czech Republic">Czechia </option> <option value="Denmark">Denmark </option> <option value="Djibouti">Djibouti </option> <option value="Dominica">Dominica </option> <option value="Dominican Republic">Dominican Republic </option> <option value="Ecuador">Ecuador </option> <option value="Egypt">Egypt </option> <option value="El Salvador">El Salvador </option> <option value="Equatorial Guinea">Equatorial Guinea </option> <option value="Eritrea">Eritrea </option> <option value="Estonia">Estonia </option> <option value="Swaziland">Eswatini </option> <option value="Ethiopia">Ethiopia </option> <option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas) </option> <option value="Faroe Islands">Faroe Islands </option> <option value="Fiji">Fiji </option> <option value="Finland">Finland </option> <option value="France">France </option> <option value="French Guiana">French Guiana </option> <option value="French Polynesia">French Polynesia </option> <option value="French Southern Territories">French Southern Territories </option> <option value="Gabon">Gabon </option> <option value="Gambia">Gambia </option> <option value="Georgia">Georgia </option> <option value="Germany">Germany </option> <option value="Ghana">Ghana </option> <option value="Gibraltar">Gibraltar </option> <option value="Greece">Greece </option> <option value="Greenland">Greenland </option> <option value="Grenada">Grenada </option> <option value="Guadeloupe">Guadeloupe </option> <option value="Guam">Guam </option> <option value="Guatemala">Guatemala </option> <option value="Guernsey">Guernsey </option> <option value="Guinea">Guinea </option> <option value="Guinea-Bissau">Guinea-Bissau </option> <option value="Guyana">Guyana </option> <option value="Haiti">Haiti </option> <option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands </option> <option value="Vatican City State">Holy See </option> <option value="Honduras">Honduras </option> <option value="Hong Kong">Hong Kong </option> <option value="Hungary">Hungary </option> <option value="Iceland">Iceland </option> <option value="India">India </option> <option value="Indonesia">Indonesia </option> <option value="Iran">Iran (Islamic Republic of) </option> <option value="Iraq">Iraq </option> <option value="Ireland">Ireland </option> <option value="Isle of Man">Isle of Man </option> <option value="Israel">Israel </option> <option value="Italy">Italy </option> <option value="Jamaica">Jamaica </option> <option value="Japan" selected="selected">Japan </option> <option value="Jersey">Jersey </option> <option value="Jordan">Jordan </option> <option value="Kazakhstan">Kazakhstan </option> <option value="Kenya">Kenya </option> <option value="Kiribati">Kiribati </option> <option value="Democratic People's Republic of Korea">Korea, Democratic People's Republic of </option> <option value="Republic of Korea">Korea, Republic of </option> <option value="Kuwait">Kuwait </option> <option value="Kyrgyzstan">Kyrgyzstan </option> <option value="Lao People's Democratic Republic">Lao People's Democratic Republic </option> <option value="Latvia">Latvia </option> <option value="Lebanon">Lebanon </option> <option value="Lesotho">Lesotho </option> <option value="Liberia">Liberia </option> <option value="Libya">Libya </option> <option value="Liechtenstein">Liechtenstein </option> <option value="Lithuania">Lithuania </option> <option value="Luxembourg">Luxembourg </option> <option value="Macao">Macao </option> <option value="Madagascar">Madagascar </option> <option value="Malawi">Malawi </option> <option value="Malaysia">Malaysia </option> <option value="Maldives">Maldives </option> <option value="Mali">Mali </option> <option value="Malta">Malta </option> <option value="Marshall Islands">Marshall Islands </option> <option value="Martinique">Martinique </option> <option value="Mauritania">Mauritania </option> <option value="Mauritius">Mauritius </option> <option value="Mayotte">Mayotte </option> <option value="Mexico">Mexico </option> <option value="Micronesia">Micronesia (Federated States of) </option> <option value="Moldova">Moldova, Republic of </option> <option value="Monaco">Monaco </option> <option value="Mongolia">Mongolia </option> <option value="Montenegro">Montenegro </option> <option value="Montserrat">Montserrat </option> <option value="Morocco">Morocco </option> <option value="Mozambique">Mozambique </option> <option value="Myanmar">Myanmar </option> <option value="Namibia">Namibia </option> <option value="Nauru">Nauru </option> <option value="Nepal">Nepal </option> <option value="Netherlands">Netherlands </option> <option value="New Caledonia">New Caledonia </option> <option value="New Zealand">New Zealand </option> <option value="Nicaragua">Nicaragua </option> <option value="Niger">Niger </option> <option value="Nigeria">Nigeria </option> <option value="Niue">Niue </option> <option value="Norfolk Island">Norfolk Island </option> <option value="Macedonia">North Macedonia </option> <option value="Northern Mariana Islands">Northern Mariana Islands </option> <option value="Norway">Norway </option> <option value="Oman">Oman </option> <option value="Pakistan">Pakistan </option> <option value="Palau">Palau </option> <option value="Palestine">Palestine, State of </option> <option value="Panama">Panama </option> <option value="Papua New Guinea">Papua New Guinea </option> <option value="Paraguay">Paraguay </option> <option value="Peru">Peru </option> <option value="Philippines">Philippines </option> <option value="Pitcairn Group of Islands">Pitcairn </option> <option value="Poland">Poland </option> <option value="Portugal">Portugal </option> <option value="Puerto Rico">Puerto Rico </option> <option value="Qatar">Qatar </option> <option value="Reunion">Réunion </option> <option value="Romania">Romania </option> <option value="Russian Federation">Russian Federation </option> <option value="Rwanda">Rwanda </option> <option value="Saint Barthelemy">Saint Barthélemy </option> <option value="Saint Helena">Saint Helena, Ascension and Tristan da Cunha </option> <option value="Saint Kitts and Nevis">Saint Kitts and Nevis </option> <option value="Saint Lucia">Saint Lucia </option> <option value="Saint Martin (French part)">Saint Martin (French part) </option> <option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon </option> <option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines </option> <option value="Samoa">Samoa </option> <option value="San Marino">San Marino </option> <option value="Sao Tome and Principe">Sao Tome and Principe </option> <option value="Saudi Arabia">Saudi Arabia </option> <option value="Senegal">Senegal </option> <option value="Serbia">Serbia </option> <option value="Seychelles">Seychelles </option> <option value="Sierra Leone">Sierra Leone </option> <option value="Singapore">Singapore </option> <option value="Saint Martin">Sint Maarten (Dutch part) </option> <option value="Slovakia">Slovakia </option> <option value="Slovenia">Slovenia </option> <option value="Solomon Islands">Solomon Islands </option> <option value="Somalia">Somalia </option> <option value="South Africa">South Africa </option> <option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands </option> <option value="South Sudan">South Sudan </option> <option value="Spain">Spain </option> <option value="Sri Lanka">Sri Lanka </option> <option value="Sudan">Sudan </option> <option value="Suriname">Suriname </option> <option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen </option> <option value="Sweden">Sweden </option> <option value="Switzerland">Switzerland </option> <option value="Syrian Arab Republic">Syrian Arab Republic </option> <option value="Taiwan (Republic of China)">Taiwan </option> <option value="Tajikistan">Tajikistan </option> <option value="United Republic of Tanzania">Tanzania, United Republic of </option> <option value="Thailand">Thailand </option> <option value="Timor-Leste">Timor-Leste </option> <option value="Togo">Togo </option> <option value="Tokelau">Tokelau </option> <option value="Tonga">Tonga </option> <option value="Trinidad and Tobago">Trinidad and Tobago </option> <option value="Tunisia">Tunisia </option> <option value="Turkey">Turkey </option> <option value="Turkmenistan">Turkmenistan </option> <option value="Turks and Caicos Islands">Turks and Caicos Islands </option> <option value="Tuvalu">Tuvalu </option> <option value="Uganda">Uganda </option> <option value="Ukraine">Ukraine </option> <option value="United Arab Emirates">United Arab Emirates </option> <option value="United Kingdom">United Kingdom </option> <option value="United States Minor Outlying Islands">United States Minor Outlying Islands </option> <option value="United States">United States </option> <option value="Uruguay">Uruguay </option> <option value="Uzbekistan">Uzbekistan </option> <option value="Vanuatu">Vanuatu </option> <option value="Venezuela">Venezuela (Bolivarian Republic of) </option> <option value="Vietnam">Viet Nam </option> <option value="Virgin Islands">Virgin Islands (British) </option> <option value="Virgin Islands (U.S.)">Virgin Islands (U.S.) </option> <option value="Wallis and Futuna">Wallis and Futuna </option> <option value="Western Sahara">Western Sahara </option> <option value="Yemen">Yemen </option> <option value="Zambia">Zambia </option> <option value="Zimbabwe">Zimbabwe </option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement7" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65335">所属する機関または組織<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65335" class="elq-item-input" name="organisation" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement8" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65357">所属する学部または学科</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65357" class="elq-item-input" name="faculty" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement9" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65337">役職</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65337" class="elq-item-input" name="title" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement10" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65338">職位<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select id="fe65338" class="elq-item-select" name="jobRole1" style="width: 100%"> <option value="">選んでください…</option> <option value="(DG APAC) Dean/ Department Chair/ Programme Head/ Department Head"> 学部長・プログラム長・学科長</option> <option value="(DG APAC) Director/Manager"> ディレクター・マネージャー</option> <option value="(DG APAC) Faculty">教職員 </option> <option value="(DG APAC) Head of Research"> 研究部門長</option> <option value="(DG APAC) Lecturer">講師 </option> <option value="(DG APAC) Librarian">図書館職員 </option> <option value="(DG APAC) Library Director"> 図書館長</option> <option value="(DG APAC) Postgraduate Student"> 大学院生</option> <option value="(DG APAC) President/ Rector/ Chancellor"> 学長・総長・理事長</option> <option value="(DG APAC) Professor">教授 </option> <option value="(DG APAC) Provost">プロボスト </option> <option value="(DG APAC) Researcher">研究員 </option> <option value="(DG APAC) Undergraduate Student"> 学部生</option> <option value="(DG APAC) University Research Administrator"> 大学の研究管理者 </option> <option value="(DG APAC) Vice President/ Vice-Rector/ Vice Chancellor"> 副学長・副総長・副理事長</option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement11" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65339">機関・組織の種類</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <select id="fe65339" class="elq-item-select" name="organisationType" style="width: 100%"> <option value="Academic ">学術機関</option> <option value="Corporate">企業</option> <option value="Healthcare">医療機関</option> <option value="Government">政府機関</option> <option value="Society/Association">学協会 </option> <option value="Other">その他</option> </select> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement18" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65363">セミナー終了後のレセプションに参加されますか？</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div id="fe65363" class="field-control-wrapper"> <div class="list-order one-column"> <input id="radio-Yes_7vwfcmk9" name="networkingDrinks" type="radio" value="Yes"> <label class="checkbox-aligned elq-item-label" for="radio-Yes_7vwfcmk9">はい</label> <br> </div> <div class="list-order one-column"> <input id="radio-No_jx0tnl5a" name="networkingDrinks" type="radio" value="No"> <label class="checkbox-aligned elq-item-label" for="radio-No_jx0tnl5a">いいえ</label> <br> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement19" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65343">特別な食事制限はありますか？<span class="elq-required">*</span></label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div id="fe65343" class="field-control-wrapper"> <div class="list-order one-column"> <input id="radio-Yes_0mhp3z8c" name="specialDietary" type="radio" value="Yes"> <label class="checkbox-aligned elq-item-label" for="radio-Yes_0mhp3z8c">はい</label> <br> </div> <div class="list-order one-column"> <input id="radio-No_9o42yj2r" name="specialDietary" type="radio" value="No"> <label class="checkbox-aligned elq-item-label" for="radio-No_9o42yj2r">いいえ</label> <br> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement20" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe65344">特別な食制限の詳細を明記してください</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <input id="fe65344" class="elq-item-input" name="specialDietaryText" style="width: 100%" type="text" value=""> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement22" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12" style="text-align: left"> <label class="elq-label" for="fe84916">講演者への質問があればお知らせください</label> </div> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div class="field-control-wrapper"> <textarea rows="5" id="fe84916" class="elq-item-textarea" name="questionSpeaker" style="width: 100%;"></textarea> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement24" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div> <div class="single-checkbox-row row"> <input id="fe92956" name="consent" type="checkbox"> <label class="checkbox-aligned elq-item-label" for="fe92956"> はい、Wiley 社の<a href="https://www.wiley.com/privacy" target="_blank">プライバシーポリシー</a>およびWiley 社の<a href="https://www.wiley.com/terms-of-use" target="_blank">利用規約</a>を読んだ上で、同意しました。<span class="elq-required">*</span> </label> </div> </div> </div> </div> </div> </div> </div> </div> </div> <br> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement24" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div> <div class="single-checkbox-row row"> <input id="fe65345" name="consent_new" type="checkbox"> <label class="checkbox-aligned elq-item-label" for="fe65345">はい、Wiley 社からの製品、サービス、イベントに関するニュース、オファー、アナウンス、アップデート、プロモーションを電子メールで受信することを希望します。</label> </div> </div> </div> </div> <div class="row"> <div class="col-xs-12"> <div> <div class="single-checkbox-row row"> <div style="font-size: 11px;"> 配信停止はいつでも可能です。</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="row"> <div class="grid-layout-col"> <div class="layout-col col-sm-12 col-xs-12"> <div id="formElement25" class="elq-field-style form-element-layout row"> <div class="col-sm-12 col-xs-12"> <div class="row"> <div class="col-xs-12"> <div> <input id="fe65355" class="submit-button-style" type="Submit" value="送信"> </div> </div> </div> </div> </div> </div> </div> </div> <input id="fe66344" name="leadsource" type="hidden" value=""> <input id="fe65346" name="CodestreamEventName" type="hidden" value=""> <input id="fe65348" name="CodestreamEventType" type="hidden" value=""> <input id="fe65350" name="CodestreamEventSubjectCode" type="hidden" value=""> <input id="fe68249" name="codestreamEventID" type="hidden" value=""> <input id="fe65353" name="utm_source" type="hidden" value=""> <input id="fe65354" name="utm_campaign" type="hidden" value=""> <input id="fe65454" name="utm_content" type="hidden" value=""> <input id="fe65455" name="utm_medium" type="hidden" value=""> </div> </form> <script src="https://images.secure.wiley.com/Web/WileyEnterprise/{38395e2b-7fe2-4749-848c-cf343852ab09}_UTMCapture.js"></script>