<form id="formExtNewslettersAPAC" accept-charset="UTF-8" action="https://m.info.wiley.com/webApp/formExtNewslettersAPAC" method="post"> <div class="form-group"> <label for="salutation">敬称*</label> <select id="salutation" name="salutation" class="custom-select" required="required"> <option value="">選択ください...</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 class="form-group"> <label for="firstName">名*</label> <input id="firstName" name="firstName" type="text" class="form-control" required="required"> </div> <div class="form-group"> <label for="lastName">姓*</label> <input id="lastName" name="lastName" type="text" class="form-control" required="required"> </div> <div class="form-group"> <label for="email">E-mail*</label> <input id="email" name="email" type="email" required="required" class="form-control"> </div> <div class="form-group"> <label for="companyName">ご所属機関名/社名*</label> <input id="companyName" name="companyName" type="text" class="form-control" required="required"> </div> <div class="form-group"> <label for="title">役職名*</label> <input id="title" name="title" type="text" class="form-control" required="required"> </div> <div class="form-group"> <label for="jobRole">職位*</label> <div> <select id="jobRole" name="jobRole" class="custom-select" required="required"> <option value="">選択ください...</option> <option value="(Librarians) Collection Development/Acquisitions Librarian">Collection Development/Acquisitions Librarian</option> <option value="(Librarians) E-Resources Librarian">E-Resources Librarian</option> <option value="(Librarians) Faculty">Faculty</option> <option value="(Librarians) Library Assistant">Library Assistant</option> <option value="(Librarians) Library Director">Library Director</option> <option value="(Librarians) Library Technician">Library Technician</option> <option value="(Librarians) Reference Librarian">Reference Librarian</option> <option value="(Librarians) Researcher">Researcher</option> <option value="(Librarians) Student">Student</option> <option value="(Librarians) Subject Librarian">Subject Librarian</option> <option value="(Librarians) University Librarian">University Librarian</option> <option value="(Librarians) Other">Other</option> </select> </div> </div> <div class="form-group"> <label for="country">国*</label> <div> <select id="country" name="country" class="custom-select" required="required"> <option value="">Please select...</option> <option value="AF">Afghanistan</option> <option value="AX">Aland Islands</option> <option value="AL">Albania</option> <option value="DZ">Algeria</option> <option value="AS">American Samoa</option> <option value="AD">Andorra</option> <option value="AO">Angola</option> <option value="AI">Anguilla</option> <option value="AQ">Antartica</option> <option value="AG">Antigua and Barbuda</option> <option value="AR">Argentina</option> <option value="AM">Armenia</option> <option value="AW">Aruba</option> <option value="AU">Australia</option> <option value="AT">Austria</option> <option value="AZ">Azerbaijan</option> <option value="BS">Bahamas</option> <option value="BH">Bahrain</option> <option value="BD">Bangladesh</option> <option value="BB">Barbados</option> <option value="BY">Belarus</option> <option value="BE">Belgium</option> <option value="BZ">Belize</option> <option value="BJ">Benin</option> <option value="BM">Bermuda</option> <option value="BT">Bhutan</option> <option value="GW">Bissau</option> <option value="BO">Bolivia</option> <option value="BA">Bosnia and Herzegovina</option> <option value="BW">Botswana</option> <option value="BV">Bouvet island</option> <option value="BR">Brazil</option> <option value="IO">British Indian Ocean Territory</option> <option value="VG">British Virgin Islands</option> <option value="BN">Brunei Darussalam</option> <option value="BG">Bulgaria</option> <option value="BF">Burkina Faso</option> <option value="BI">Burundi</option> <option value="KH">Cambodia</option> <option value="CM">Cameroon</option> <option value="CA">Canada</option> <option value="CV">Cape Verde</option> <option value="KY">Cayman islands</option> <option value="CF">Central Africa Republic</option> <option value="TD">Chad</option> <option value="CL">Chile</option> <option value="CN">China</option> <option value="CX">Christmas Island</option> <option value="CC">Coco Islands</option> <option value="CO">Colombia</option> <option value="KM">Comoros</option> <option value="CK">Cook Islands</option> <option value="CR">Costa Rica</option> <option value="HR">Croatia</option> <option value="CU">Cuba</option> <option value="CY">Cyprus</option> <option value="CZ">Czech Republic</option> <option value="CD">Democratic Republic of Congo</option> <option value="DK">Denmark</option> <option value="DJ">Djibouti</option> <option value="DM">Dominica</option> <option value="DO">Dominican Republic</option> <option value="EC">Ecuador</option> <option value="EG">Egypt</option> <option value="SV">El Salvador</option> <option value="GQ">Equatorial Guinea</option> <option value="ER">Eritrea</option> <option value="EE">Estonia</option> <option value="ET">Ethiopia</option> <option value="FO">Faeroe Islands</option> <option value="FK">Falkland Islands</option> <option value="FJ">Fiji</option> <option value="FI">Finland</option> <option value="FR">France</option> <option value="GF">French Guiana</option> <option value="PF">French Polynesia</option> <option value="TF">French Southern Territories</option> <option value="GA">Gabon</option> <option value="GM">Gambia</option> <option value="GE">Georgia</option> <option value="DE">Germany</option> <option value="GH">Ghana</option> <option value="GI">Gibraltar</option> <option value="GR">Greece</option> <option value="GL">Greenland</option> <option value="GD">Grenada</option> <option value="GP">Guadeloupe</option> <option value="GU">Guam</option> <option value="GT">Guatemala</option> <option value="GN">Guinea</option> <option value="GY">Guyana</option> <option value="HT">Haiti</option> <option value="HM">Heard Island and McDonald Islands</option> <option value="HN">Honduras</option> <option value="HK">Hong Kong (SAR China)</option> <option value="HU">Hungary</option> <option value="IS">Iceland</option> <option value="IN">India</option> <option value="ID">Indonesia</option> <option value="IR">Iran</option> <option value="IQ">Iraq</option> <option value="IE">Ireland</option> <option value="IL">Israel</option> <option value="IT">Italy</option> <option value="CI">Ivory Coast</option> <option value="JM">Jamaica</option> <option value="JP">Japan</option> <option value="JO">Jordan</option> <option value="KZ">Kazakhstan</option> <option value="KE">Kenya</option> <option value="KI">Kiribati</option> <option value="KR">Korea</option> <option value="KW">Kuwait</option> <option value="KG">Kyrgyzstan</option> <option value="LA">Lao</option> <option value="LV">Latvia</option> <option value="LB">Lebanon</option> <option value="LS">Lesotho</option> <option value="LR">Liberia</option> <option value="LY">Libya</option> <option value="LI">Liechtenstein</option> <option value="LT">Lithuania</option> <option value="LU">Luxembourg</option> <option value="MO">Macau (SAR China)</option> <option value="MK">Macedonia</option> <option value="MG">Madagascar</option> <option value="MW">Malawi</option> <option value="MY">Malaysia</option> <option value="MV">Maldives</option> <option value="ML">Mali</option> <option value="MT">Malta</option> <option value="MH">Marshall Islands</option> <option value="MQ">Martinique</option> <option value="MR">Mauritania</option> <option value="MU">Mauritius</option> <option value="YT">Mayotte</option> <option value="MX">Mexico</option> <option value="FM">Micronesia</option> <option value="MD">Moldova</option> <option value="MC">Monaco</option> <option value="MN">Mongolia</option> <option value="ME">Montenegro</option> <option value="MS">Montserrat</option> <option value="MA">Morocco</option> <option value="MZ">Mozambique</option> <option value="MM">Myanmar</option> <option value="NA">Namibia</option> <option value="NR">Nauru</option> <option value="NP">Nepal</option> <option value="NL">Netherlands</option> <option value="AN">Netherlands Antilles</option> <option value="NC">New Caledonia</option> <option value="NZ">New Zealand</option> <option value="NI">Nicaragua</option> <option value="NE">Niger</option> <option value="NG">Nigeria</option> <option value="NU">Niue</option> <option value="NF">Norfolk Island</option> <option value="KP">Northern Korea</option> <option value="MP">Northern Mariana Islands</option> <option value="NO">Norway</option> <option value="OM">Oman</option> <option value="PK">Pakistan</option> <option value="PW">Palau</option> <option value="PS">Palestinian territories</option> <option value="PA">Panama</option> <option value="PG">Papua New Guinea</option> <option value="PY">Paraguay</option> <option value="PE">Peru</option> <option value="PH">Philippines</option> <option value="PN">Pitcairn</option> <option value="PL">Poland</option> <option value="PT">Portugal</option> <option value="PR">Puerto Rico</option> <option value="QA">Qatar</option> <option value="CG">Republic of Congo</option> <option value="RO">Romania</option> <option value="RU">Russia</option> <option value="RW">Rwanda</option> <option value="RE">Réunion</option> <option value="KN">Saint Kitts and Nevis</option> <option value="LC">Saint Lucia</option> <option value="PM">Saint Pierre and Miquelon</option> <option value="VC">Saint Vincent and the Grenadines</option> <option value="SH">Saint elena</option> <option value="WS">Samoa</option> <option value="SM">San Marino</option> <option value="ST">Sao Tome and Principe</option> <option value="SA">Saudi Arabia</option> <option value="SN">Senegal</option> <option value="RS">Serbia</option> <option value="SC">Seychelles</option> <option value="SL">Sierra Leone</option> <option value="SG">Singapore</option> <option value="SK">Slovakia</option> <option value="SI">Slovenia</option> <option value="SB">Solomon Islands</option> <option value="SO">Somalia</option> <option value="ZA">South Africa</option> <option value="GS">South Georgia and the South Sandwich Islands</option> <option value="ES">Spain</option> <option value="LK">Sri Lanka</option> <option value="SD">Sudan</option> <option value="SR">Suriname</option> <option value="SJ">Svalbard and Jan Mayen</option> <option value="SZ">Swaziland</option> <option value="SE">Sweden</option> <option value="CH">Switzerland</option> <option value="SY">Syria</option> <option value="TW">Taiwan</option> <option value="TJ">Tajikistan</option> <option value="TZ">Tanzania</option> <option value="TH">Thailand</option> <option value="TL">Timor-Leste</option> <option value="TG">Togo</option> <option value="TK">Tokelau</option> <option value="TO">Tonga</option> <option value="TT">Trinidad and Tobago</option> <option value="TN">Tunisia</option> <option value="TR">Turkey</option> <option value="TM">Turkmenistan</option> <option value="TC">Turks and Caicos Islands</option> <option value="TV">Tuvalu</option> <option value="VI">U.S. Virgin Islands</option> <option value="UG">Uganda</option> <option value="UA">Ukraine</option> <option value="AE">United Arab Emirates</option> <option value="GB">United Kingdom</option> <option value="US">United States</option> <option value="UM">United States Minor Outlying Islands</option> <option value="UY">Uruguay</option> <option value="UZ">Uzbekistan</option> <option value="VU">Vanuatu</option> <option value="VA">Vatican</option> <option value="VE">Venezuela</option> <option value="VN">Vietnam</option> <option value="WF">Wallis and Futuna</option> <option value="EH">Western Sahara</option> <option value="YE">Yemen</option> <option value="ZM">Zambia</option> <option value="ZW">Zimbabwe</option> </select> </div> </div> <div class="form-group"> <label>どのようなお知らせやプロモーションを受け取りたいですか？</label> <div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="productInterest" id="productInterest_0" type="checkbox" class="custom-control-input" value="Wiley Events & Webinars"> <label for="productInterest_0" class="custom-control-label">Wileyのイベントやウェビナーの情報</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="productInterest" id="productInterest_1" type="checkbox" class="custom-control-input" value="Wiley News"> <label for="productInterest_1" class="custom-control-label">Wileyのニュースや最新情報</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="productInterest" id="productInterest_2" type="checkbox" class="custom-control-input" value="Products"> <label for="productInterest_2" class="custom-control-label">製品</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="productInterest" id="productInterest_3" type="checkbox" class="custom-control-input" value="None of the above"> <label for="productInterest_3" class="custom-control-label">上記のどれにも当てはまらない</label> </div> </div> </div> </div> <div class="form-group"> <label>ご興味のある分野・領域にチェックを入れて下さい</label> <div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_0" type="checkbox" class="custom-control-input" value="Earth & Environmental Sciences"> <label for="subjectInterest_0" class="custom-control-label">Earth &amp; Environmental Sciences</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_1" type="checkbox" class="custom-control-input" value="Life Sciences"> <label for="subjectInterest_1" class="custom-control-label">Life Sciences</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_2" type="checkbox" class="custom-control-input" value="Medicine"> <label for="subjectInterest_2" class="custom-control-label">Medicine</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_3" type="checkbox" class="custom-control-input" value="Nursing, Dentistry & Healthcare"> <label for="subjectInterest_3" class="custom-control-label">Nursing, Dentistry &amp; Healthcare</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_4" type="checkbox" class="custom-control-input" value="Physical Sciences & Engineering"> <label for="subjectInterest_4" class="custom-control-label">Physical Sciences &amp; Engineering</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_5" type="checkbox" class="custom-control-input" value="Social Sciences & Humanities"> <label for="subjectInterest_5" class="custom-control-label">Social Sciences &amp; Humanities</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_6" type="checkbox" class="custom-control-input" value="Not applicable"> <label for="subjectInterest_6" class="custom-control-label">該当しない</label> </div> </div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="subjectInterest" id="subjectInterest_7" type="checkbox" class="custom-control-input" value="Others"> <label for="subjectInterest_7" class="custom-control-label">その他</label> </div> </div> </div> </div> <div class="form-group"> <label for="subjectInterestOthers">その他の場合、分野・領域を詳しく入力して下さい </label> <input id="subjectInterestOthers" name="subjectInterestOthers" type="text" class="form-control"> </div> <div class="form-group"> <div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="privacyPolicy" id="privacyPolicy" type="checkbox" required="required" class="custom-control-input" value="true"> <label for="privacyPolicy" class="custom-control-label">はい、Wileyの <a href="https://www.wiley.com/privacy" target="_blank">プライベートポリシー</a> と、</a><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す。</a>*</label> </div> </div> </div> </div> <div class="form-group"> <div> <div class="custom-controls-stacked"> <div class="custom-control custom-checkbox"> <input name="consent" id="consent" type="checkbox" class="custom-control-input" value="true"> <label for="consent" class="custom-control-label">はい、Wileyの製品、サービスやイベント情報などのプロモーションを受け取ることを希望します。</label> </div> </div> </div> </div> <input id="vid" name="vid" type="hidden" value=""> <input type="hidden" name="product" id="" value=""> <input type="hidden" name="interest" id="" value=""> <input id="utm_campaign" name="utm_campaign" type="hidden" value=""> <input id="utm_content" name="utm_content" type="hidden" value=""> <input id="utm_medium" name="utm_medium" type="hidden" value=""> <input id="utm_source" name="utm_source" type="hidden" value=""> <input id="utm_term" name="utm_term" type="hidden" value=""> <div class="form-group"> <button name="submit" type="submit" class="btn btn-primary">送信</button> </div> </form> <script src="https://ajax.googleapis.com/ajax/libs/jquery/3.7.0/jquery.min.js"></script> <script> $('input[name="productInterest"]').change(function(){ var subs = $.map($(':checkbox[name=productInterest]:checked'), function(n, i){ return n.value; }).join(','); $('input[name="product"]').val(subs); }); $('input[name="subjectInterest"]').change(function(){ var subs = $.map($(':checkbox[name=subjectInterest]:checked'), function(n, i){ return n.value; }).join(','); $('input[name="interest"]').val(subs); }); </script>