Symposium
Registration Form

Please Print All Information

First (given) Name Last (family/surname) Name

Title or position Company/Organization Name

Street

City State/Province Postal Code Country

Phone Number Fax Number E-mail Address

Guest Name (if attending)

Please indicate preference for your confirmation: e-mail fax postal mail

Registration Fees

On or before 10 September 2003 After 10 September 2003

Regular Fee 30,000 Yen 40,000 Yen

Student Fee (inside Japan) 5,000 Yen 5,000 Yen

Student Fee (outside Japan) Free of charge Free of charge

Total amount: Yen

Note: Registration fee for regular participants includes both tutorial and technical session proceedings and admissions to these sessions, banquet and coffee breaks. Registration fee for students, both inside and outside of Japan, includes both tutorial and technical session proceedings and admissions to these sessions and coffee breaks, but excludes admission to the banquet.

Payment Method (check one of methods)

Bank Transfer: I will remit/have remitted the registration fee by bank transfer to the following account.

Account #: 2110240

Account Holder: APNOMS

Name of Bank: Bank of Tokyo-Mitsubishi, Tachikawa Branch, Tokyo, Japan

(Date of remittance (DD/MM/YY): / / , Applicant's name of remittance: )

Note: All the remittance must be received no later than 26 September 2003. All bank service charges for the payment of the registration fee must be paid by the applicants.

On-Site: I will pay the registration fee at the symposium. Only cash payment will be accepted.

Charge to my: VISA Master Card Expiration Date (Month/Year) /

Card Number | | | | | | | | | | | | | | | | | | | |

/

Cardholder's Name (please print) Signature Date

REFUND POLICY: No refund for registration fee after 15 September 2003. There is a 5,000 Yen cancellation fee for regular registration on or before this date. All registration cancellations must be received in writing or via email.

Please send completed registration form to:

Eiji Ohira, Finance Co-Chair of APNOMS 2003

Systems Development Laboratory, Hitachi, Ltd.,

1099, Ohzenji, Asao-Ku, Kawasaki-shi, Kanagawa-ken 215-0013, Japan

Fax:+81-44-959-0851,

E-mail: ei-ohira@sdl.hitachi.co.jp

Note: All registrations by card payment must be made either by FAX or via postal mail.

To Register

FAX: +81-44-959-0851, E-mail: ei-ohira@sdl.hitachi.co.jp

Postal mail: The postal address is shown in the bottom of this form.

*All registrations by card payment must be made either by FAX or via postal mail.