Registration Form
- Pre-Registrayion Deadline: December 15, 1998
- Fill in the form and fax or e-mail to EcoDesign '99 :
- Fax:+81-3-5814-1459
- E-mail: van@bcasj.or.jp
-
Name:
(Family Name) , (First Name) (Middle Initial) |
Title: ( )Prof. ( )Dr. ( )Mr. ( )Ms |
Affiliation:
|
Address: |
Country: |
Zip Code: |
E-mail: |
Telephone: |
Fax: |
Registration Fees
| Registration Fees |
Advanced
Fee
(prior to Dec.15,’98) |
On
Site Fee
(afterDec.16,’98) |
| Conference: |
check in ( ) |
|
| Member* Non-Member
Student (excludes Party)
Party for Student |
(
) ¥45,000-
( ) ¥50,000-
( ) ¥5,000-
( ) ¥5,000- |
(
) ¥50,000-
( ) ¥55,000-
( ) ¥10,000-
( ) ¥5,000- |
| Tutorial: |
|
|
| All |
(
) ¥10,000- |
(
) ¥10,000- |
| Total |
¥ |
¥ |
* sponsored societies and IEEE’ members |
Remittance
Remittance: |
( ) Bank Check enclosed (payable to EcoDesign ’99) |
( ) Bank Transfer on
|
(date) |
from |
(your
bank/branch) |
( ) Credit Card: ( ) Amex ( ) Visa ( ) Master(UC) ( ) Diners
Card Number:
*If you want use credit card, please use FAX for
this information. |
Expiry Date: |
|