[contact-form to=’info@41-22-lady.net,info@41-22.net,sh0ta18@gmail.com’ subject=’夫婦問題女性レスキュー隊’][contact-field label=’お名前’ type=’name’ required=’1’/][contact-field label=’性別’ type=’radio’ required=’1′ options=’女性,男性’/][contact-field label=’年齢’ type=’text’ required=’1’/][contact-field label=’ご住所（都道府県名だけでも可）’ type=’text’ required=’1’/][contact-field label=’携帯電話番号’ type=’text’ required=’1’/][contact-field label=’メールアドレス’ type=’email’ required=’1’/][contact-field label=’ご相談内容’ type=’textarea’ required=’1’/][/contact-form]
