2001 ICEP
REGISTRATION

[Deadline for Early Registration : March 30, 2001]

Please address to:
Secretariat of 2001 ICEP
IMAPS Japan / JIEP
3-12-2 Nishiogikita, Suginami-ku, Tokyo 167-0042, Japan
Tel : +81-3-5310-2010, Fax : +81-3-5310-2011

(Please type or print in block letters, check the appropriate boxes below)

(Date)__________ ,__________ , 2001
1. Full Name
  (Check) [   ]Prof. [   ]Dr. [   ]Mr. [   ]Ms. / [   ]Speaker [   ]Chairperson [   ]Committee
  (First Name) _____________________________________________ (Last Name) _____________________________________________ 
  If you are an IEEE / IMAPS / JIEP member, please fill out your membership No. bellow.
  [   ]IEEE / [   ]IMAPS / [   ]JIEP No.: ________________________________, [   ]Non-Member 
2. Company / Institution
 
  (Div./Dept)
3. Mailing Address
  (Check) [   ]Office [   ]Home
　
  TEL________________________________________________________
  FAX________________________________________________________
  E-mail_______________________________________________________________
  (Zip/Area Code)______________________________ (Country)______________________________ 
4. Registration Fees

Check

Category

Advance by
March 30

On or after
March 31

Contents
　 Member of IEEE / IMAPS / JIEP 
(Including Company Member of JIEP) 
Speaker, Chairperson		 35,000 yen 40,000 yen Including Reception and 
Proceedings
　 Non-Member 45,000 yen 50,000 yen
　 Student 5,000 yen Including Proceedings
　 Accompanying Spouse 5,000 yen 　
　 Welcome Reception Only 8,000 yen 　
　 Extra Proceedings 10,000 yen 　
  All payment should be made in Japanese Yen. Other currencies can't be accepted.
  Only the payment method described bellow will be acceptable. No personal check will be allowed.
5. Remittance
  [   ]I have remitted the above sum of ____________________ yen by bank transfer through my bank
  _____________________________________________________ (name of your bank) to account of
  A/C Name: Symposium Organizing Committee A/C Number: 0798033 Tokyo Mitsubishi Bank, Nishiogikubo Branch
   (Please enclose a copy of bank's receipt to avoid possible trouble)
  [   ]Credit Card
     [   ]VISA Card [   ]Master Card
     Card No. ___________________-___________________-___________________-___________________  Expiration Date (M)__________/(Y)__________
     Holder's Name ______________________________________________  Home Tel. Number ________________________________________________
     Holder's Signature_________________________________________________  Date _____________________________________________

(HP)