Deadline: March 7, 2001
Type or print in BLOCK LETTERS.
Name:
Prof./Dr./Mr./Mrs./Ms./
_____________________________________________________________________
Last Name
First Name
Middle
Initial*
Company/Organization: _____________________________________________________
Address: ________________________________________________________________
_____________________________________________________________________
Mail Stop:
City/State/Country:
Phone: ____________________________ Fax: __________________________________
E-mail: __________________________________________________________________
Accompanying
Person(s), if any: _______________________________________________
Last Name
First Name
Hotel Accommodations:
|
Name of Hotel |
Number of
Room(s) |
Period of Stay |
|
1st Choice _____________ 2nd Choice _____________ |
_____ Twin room(s) _____ Deluxe Single room(s) _____ Single
room(s) |
Check-in: ______________ Check-out: _____________ _______________
Night(s) |
|
Hotel deposit:
10, 000 yen x
room (s) = _____________________ yen (A) |
||
Communication Fee (Postage etc.) = 500 yen(B)
Grand Total= (A) + (B) = ___________________________________________ yen
□ I am enclosing an international
check or money order of the above total amount in Japanese Yen drawn on a
Japanese bank, payable to the Japan Travel Bureau, Inc. (Personal checks will
not be accepted.)
□ I charge the above total to my credit card.
Record of Charges
Total
Amount: _____________________________________ yen
Credit
Card Type: Diners / Master Card / VISA / JCB / AMEX
Credit
Card No.: ______________________________________________________
Expiration
Date: ______________________________________________________
Name
as it appears on card: ______________________________________________
Cardholder
Signature: ___________________________________________________
Date:
_____________________ Signature: __________________________________
(This application will be valid upon your receiving confirmation from JTB.)
Reservations (ICMTS 2001)
Japan Travel Bureau, Inc.(JTB)
Tours & Convention Division
Nittochi-Dojimahama, Kita-ku
Osaka 530-0004, Japan
Name to be printed on badge:
_________________________________________________________________________
Last Name
First Name
Middle Initial
Company/Organization: _______________________________________________________
Mailing Address*: ___________________________________________________________
Phone No.: ______________________________ Fax No.: __________________________
E-mail: ____________________________________________________________________
Member (IEEE / IEICE / JSAP) Number __________________________________________
Registration Fees:
(Late fee applies if postmarked after February 1, 2001)
|
|
Member** |
Non Member |
Student*** |
|||
|
|
Early |
Late |
Early |
Late |
Early |
Late |
|
Tutorial |
18,000 |
25,000 |
21,000 |
28,000 |
8,000 |
10,000 |
|
Technical |
35,000 |
38,000 |
43,000 |
46,000 |
25,000 |
26,000 |
|
Extra Banquet
Ticket |
12,000 |
12,000 |
|
|
||
|
Extra
Proceedings |
5,000 |
7,000 |
|
|
||
Excursion 4,000 yen/person x __________ = ___________ yen
5% Credit Card “Only”: _____________________________________
TOTAL AMOUNT: ____________________________________ yen
On-site Registration Fees-see page 2.
* As you want it to appear on the Conference List of Attendees
** Must be a member of IEEE or IEICE
or JSAP.
*** To qualify for reduced conference rates, you must be a Student Member, a full-time student, not be self-employed, nor working part or full time at a facility or corporation.
Payment: Bank Transfer /Bank Check /Credit Card /Cash at the Conference
For Credit Card:
Charge Fees plus 5% to my credit card:
Master Card/VISA/Diner’s Club/AMEX
Card Number: ____________________________________________
Expiration Date: ___________________________________________
Name as it appears on card: __________________________________
Cardholder Signature: _______________________________________
SEND FORM AND REMITTANCE TO:
ICMTS 2001 Secretariat
c/o Center for Academic Societies Japan, Osaka
1-4-2 Shinsenrihigashi-machi Toyonaka Osaka 560-0082, Japan
Phone: +81-6-6873-2301 Fax: +81-6-6873-2300
E-mail: o-conf@bcasj.or.jp