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<title>星野つよし 公式ホームページ - 自民党 衆議院議員 神奈川県第12選挙区(藤沢市・寒川町)支部長 星野つよし 公式ホームページ</title>
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<h1><a href="../"><img src="img/logo.png" alt="星野つよし"></a></h1>
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<h2>各種ご案内</h2>
<h3>Information</h3>
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<li>各種ご案内</li>
<li><span>お問い合わせ・ご意見・ご相談</span></li>
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<h2>お問い合わせ・ご意見・ご相談</h2>
<div><p>ご意見・お問い合わせは下記フォームよりご連絡ください。</p></div>
<form action="contact.php" method="post">
<table>
<tbody><tr>
<th class="back text-l" width="30%">お問い合わせ項目<span class="float-r text-red">*</span></th>
<td><label><input type="radio" name="contactitem" value="お問い合わせ">お問い合わせ</label>
<label><input type="radio" name="contactitem" value="ご意見">ご意見</label>
<label><input type="radio" name="contactitem" value="その他">その他</label></td>
</tr>
<tr>
<th class="back text-l">お問い合わせ内容<span class="float-r text-red">*</span></th>
<td><textarea name="comment" rows="6" id="textarea" class="textJs"></textarea>
<p id="count">あと500字</p></td>
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<th class="back text-l">お名前<span class="float-r text-red">*</span></th>
<td>
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<tbody>
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<td class="p_i" width="50%"><input type="text" name="name1" placeholder="例)星野" value="" class="textJs"></td>
<td width="50%"><input type="text" name="name2" placeholder="例)剛士" value="" class="textJs"></td>
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<td width="50%"><input type="text" name="furigana2" placeholder="例)つよし" value="" class="textJs"></td>
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<p>確認のため再度ご入力下さい。</p>
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