Ina Ski! Winter Fireworks Message Submission Form

Name※ Postal Code※ Address※ Prefecture --- Hokkaido Aomori Akita Iwate Yamagata Miyagi Fukushima Ibaraki Tochigi Gunma Chiba Saitama Tokyo Kanagawa Niigata Nagano Yamanashi Fukui Ishikawa Toyama Shizuoka Gifu Aichi Mie Shiga Kyoto Osaka Hyogo Nara Wakayama Tottori Shimane Okayama Hiroshima Yamaguchi Tokushima Kagawa Ehime Kochi Fukuoka Saga Nagasaki Kumamoto Oita Miyazaki Kagoshima Okinawa Address ※Please enter your address in detail（include mansion name etc.） Phone #（Mobile is OK）※ Email Address※ Desired Date※ Feb. 12, 2022 (Sat) Feb. 19, 2022 (Sat) Feb. 26, 2022 (Sat) Mar. 5, 2022 (Sat) Mar. 12, 2022 (Sat) Mar. 19, 2022 (Sat) Message※ ※Within 100 characters Name to be read aloud※ ※Nicknames are OK