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[{"$nulls":7},"（様式４）"]
[{"$nulls":7},"令和　　年　　月　　日"]
[]
[]
[]
[]
[{"$nulls":5},"公立文化施設等長"]
[{"$nulls":5},"氏 名",null,"印"]
[]
[]
["令和３年度優秀映画鑑賞推進事業実施報告書"]
[]
[null,"このことについて、下記のとおり報告します。"]
[]
["記"]
[]
["１ 概要"]
[null,"(1)","実施会場名","：",null,null,null,"　"]
[]
[{"$nulls":4},"都道府県",null,"市町村"]
[]
[null,"(2)","実施プログラム名","：",null,"プログラム"]
[]
[null,"(3)","実施期間","：","令和　　年　　月　　日（　　）　～　　月　　日（　　）"]
[]
[{"$nulls":4},"合計　　　　　","日間"]
[]
[null,"(4)","担当者名","：",null,null,null,"　"]
[null,null,"連絡先ＴＥＬ","："]
[null,null,"メールアドレス","："]
[]
[null,"(5)","当事業の実施回数","：","合計　　　　　","回（本年度を含む）"]
[]
[null,"(6)","入場者数","：","　"]
[null,"上映作品名",null,null,null,"上映回数(回）","入場者数(人）","１回平均\n入場者数(人）"]
[]
[null,1]
[null,2]
[null,3]
[null,4]
[null,"全作品計",null,null,null,"上映回数合計","入場者数合計","1回平均入場者数"]
[{"$nulls":5},"　","　"]
[]
[{"$nulls":5},1]

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[]
["２ 事業記録"]
[]
["(1)入場者数","（注）","入場者数の記載にあたっては、1回の上映ごとに入替制を行ったものとみなして入場者数を算出するものとする。"]
[]
["上映作品名",null,"上映日","上映時間","入場者数（人）"]
[1,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
[null,null,null,"小計"]
[null,null,null,"１回平均"]
[2,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
["　",null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,null,"小計"]
[null,null,null,"１回平均"]
[3,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
[null,"　","　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
["　",null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
[null,null,null,"小計"]
[null,null,null,"１回平均"]
[4,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分","　"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,"　月　　日","　　　時　　　分　～　　　時　　　分"]
[null,null,null,"小計"]
[null,null,null,"１回平均"]
["計",null,"上映日数合計","延べ上映回数","１回平均入場者数"]
[null,null,"日","　　　　　　回","　　　　人"]
[]
["(2)収支決算"]
["収　　　入",null,null,"支　　　出　"]
["事　　項",null,"金　額","事　　項","金　額"]
[null,null,"円",null,"円"]
["①事業費",null,null,"①広報紙印刷費"]
["②観覧料",null,null,"②観覧券印刷費"]
["③補助金",null,null,"③会場使用料"]
["④その他",null,null,"④会場設営費（映写機借上代含）"]
[null,null,null,"⑤映写技師経費"]
[null,null,null,"⑥会場整理要員費"]
[null,null,null,"⑦実行委員会に要した経費"]
[null,null,null,"⑧その他"]
[]
["計",null,0,"計",0]
[]
[null,null,null,2]

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[]
["(3)アンケートの集計 　※実施日が数日ある場合、まとめたデータを記入してください"]
[]
["総入場者数",null,"　　　　名","提出数","　　　　名","回答率","　　　　　％"]
["　"]
[null,"①性別","男","　　　　名","女","　　　　名","無回答","　　　　名"]
[]
[null,"②年齢","２０歳未満","　　　　名","２０代","　　　　名","３０代","　　　　名"]
[null,null,"４０代　　","　　　　名","５０代","　　　　名","６０代","　　　　名"]
[null,null,"７０歳以上","　　　　名","　　無回答　 ","　　　　名"]
[]
[null,"③住所","会場のある地域","　　　　名","近隣の地域","　　　　名","それ以外","　　　　名"]
[]
[null,"④大人/こども　※アンケートに記入された子どもの数の集計"]
[null,null,"子ども","　　　　名","　","　",null,"　"]
[]
[null,"⑤情報入手方法"]
[null,null,"広報誌","　　　　名",null,"ポスター・チラシ","　　　　名"]
[null,null,"知人・口コミ","　　　　名",null,"その他（具体的に）","　　　　　　　　　　　　　　　",null,"　"]
[null,null,"無回答","　　　　名"]
[]
[null,"⑥１年間の映画鑑賞回数"]
[null,null,"映画館やホール","０本","　　　　名"," １～２本","　　　　名"]
[null,null,null,"３～５本","　　　　名","６～１０本","　　　　名","　"]
[null,null,null,"それ以上","　　　　名","無回答","　　　　名"]
[]
[null,null,"ビデオやＤＶＤ","０本","　　　　名"," １～２本","　　　　名"]
[null,null,null,"３～５本","　　　　名","６～１０本","　　　　名","　"]
[null,null,null,"それ以上","　　　　名","無回答","　　　　名"]
[]
[null,null,"テレビで","０本","　　　　名"," １～２本","　　　　名"]
[null,null,null,"３～５本","　　　　名","６～１０本","　　　　名","　"]
[null,null,null,"それ以上","　　　　名","無回答","　　　　名"]
[]
[null,null,"インターネットで（動画配信などを含む）"]
[null,null,null,"０本","　　　　名"," １～２本","　　　　名"]
[null,null,null,"３～５本","　　　　名","６～１０本","　　　　名"]
[null,null,null,"それ以上","　　　　名","無回答","　　　　名"]
[]
[null,"⑦感想",null,"全体としてよかった","　　　　名","全体としてよくなかった",null,"　　　　名"]
[null,null,null,"どちらとも言えない","　　　　名","無回答","　　　　名"]
[]
["３　添付資料 "]
["※","ポスター、チラシ、入場券、その他事業を実施する上で作製された印刷物等を添付して下さい。"]
[]
["４　意見・感想等",null,null,"※別紙作成"]
["※","実施担当者の意見・感想等のほか、２(3)で集計したアンケートの主な意見・感想（設問⑦）等も記載して下さい。"]
[]
[5,"本事業の今後の参考とするため、①実施会場における、年間の映画上映回数と種類、②実施会場を利用している名画鑑賞会等の上映活動があればその名称、③実施会場のデジタル上映設備について、を記載して下さい。"]
[]
[]
["①","【自主事業】フィルム　　回／デジタル　　回　　【貸館事業】フィルム　　回／デジタル　　回　"]
[]
["②","名画鑑賞会名"]
["　＊該当するものに〇をしてください。"]
["③","上映設備：DCP上映設備（有／無）　　デジタル上映時の使用メディア（DCP／Blu-ray／DVD／他）"]
["　＊映画のデジタル上映時に使用している機器について、メーカー、品番をご記入ください（借用機器の場合は記入不要）。"]
[null,"再生デッキ：　　　　　　　　　　　　　プロジェクター："]
[{"$nulls":4},3]