|
You can print out this form and send your registration via facsimile (+81-774-38-4336). |
|
Hazards 2000 Registration Form |
|
Name |
(Prof. / Dr. / Mr. / Ms.)
|
Organization |
|
Address |
|
Telephone |
|
Facsimile |
|
E-mail |
|
NHS Member (Yes / No) |
|
Accompanying person(s) |
|
|
|
Conference Fee and Payment |
(Please check in .) |
|
|
Symposium Participants: |
|
NHS members |
30,000yen (Before April 1, 2000) |
|
33,000yen (After April 1, 2000 or On-Site) |
All Others |
33,000yen (Before April 1, 2000) |
|
36,000yen (After April 1, 2000 or On-Site) |
|
|
Accompanying Persons: |
|
NHS members |
10,000yen |
All Others |
11,000yen |
|
|
TOTAL |
yen |
|
|
I will pay by credit card. |
|
VISA |
Master Card |
Card Number: |
|
Expiry Date: |
|
Card Holder's Name: |
|
Signature: |
|
Date:
|
Signature:
|
|
Please return the completed registration form via facsimile to: |
Toyoko Shimizu, Hazards 2000 Secretariat
DRS, DPRI, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan
Tel : +81-774-38-4273 Fax : +81-774-38-4336 E-mail : shimizu@drs.dpri.kyoto-u.ac.jp
|
PDF Form |
|
|