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.
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 amil
Registration Fees
On or before 20 September 2003
After 20 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