AIM'97 Registration Form
Title: [ ]Prof., [ ]Dr., [ ]Mr., [ ]Ms., [
]Other___________
Name: (Surname)___________________ (First name)__________________ (Middle name)__________________
Affiliation:__________________________________________________________________________
Mailing Address:______________________________________________________________________
_______________________________________________________________ Country:______________
Phone:_____________________ Fax:_____________________ E-mail:_________________________
(1) Conference (Banquet is not included) :
Member,---- [ ]JPY30,000 / [ ]JPY35,000
Non-member, [ ]JPY35,000 / [ ]JPY40,000
Student,--- [ ]JPY15,000 / [ ]JPY20,000
Amount of conference fee JPY___________
(2) Workshop :
Workshop1, [ ]JPY 5,000 / [ ]JPY 6,000
Workshop2, [ ]JPY 5,000 / [ ]JPY 6,000
Workshop3, [ ]JPY 5,000 / [ ]JPY 6,000
Amount of workshop fee JPY___________
(3) Banquet : JPY10,000 X ___ person=JPY___________
(4) Conference including one Banquet : (In this case, we will publish only one receipt in the title of 'Conference fee' for your convenience)
Member,---- [ ]JPY 40,000 / [ ]JPY 45,000
Non-Member, [ ]JPY 45,000 / [ ]JPY 50,000
Student,--- [ ]JPY 25,000 / [ ]JPY 30,000
TOTAL AMOUNT JPY_______________
Mon. 16, June: [ ]TT-A, [ ]TT-B
Tue. 17, June: [ ]TT-C
Wed. 18, June: [ ]TT-C
Thu. 19, June: [ ]TT-C
Fri. 20, June: [ ]TT-D, [ ]TT-E
1. Transportation expenses will be required. Payment should
be made at the conference site.
2. Please note that since the number of paticipants for the tour is limited,
the list of accepted person is announced at the registration desk. Please
stop by the registration desk for detail.
Payment
[ ] Charge the amount of JPY_________ as registration fee to the following credit card
[ ]Visa, [ ]Master
Account No.:______________________________ Holder'sname:______________________________
Expiration date:___________ Signature:_____________________________________
[ ] I have sent the fee by bank transfer of JPY___________ as registration fee through
________________________________________________ (name and address of your bank)
on________________________(date of remittance)
TO: Roppongi Branch, Dai-ichi Kangyo Bank Account Title: AIM
Ordinary Account No.: 1965299 Phone: +81-3-3405-6611
AIM'97 Secretariat, c/o Prof.H.Hashimoto Institute of Industrial Science, The University of Tokyo Roppongi 7-22-1, Minato-ku, Tokyo 106, JAPAN Phone: +81-3-3402-6231 (Ext.2360) Fax: +81-3-3423-1484
(Before printing, change page setup as left margin : 1cm, right margin : 1cm, top margin : 1cm, bottom margin : 1cm, paper : A4)