Please apply using the registration form below and return by April 30, 2001. You may send the form to us by airmail, fax, or e-mail. Your registration will be confirmed when we receive your conference fee.
IMS 2001 Organizing Committee
Tokyo Denki University
2-1200 Muzai-Gakuendai, Inzai, Chiba 270-1382, JAPAN
Fax: +81-476-46-8027 or +81-476-46-8013
E-mail: email@example.com (Cc. firstname.lastname@example.org )
Prof. Dr.@ Mr.@ Mrs.@ Ms.@ Miss
Middle Name Initial:
Organization / Dept.:
Please indicate the address you wish IMS 2001 to send materials to:
Professional Address@ Home Address
Payment should be made only in Japanese Yen (Until March 31, 2001: 30,000-: After April 1, 2001: 35,000-). Personal checks are NOT acceptable. Please send application fee by April 30, 2001. After receiving the application form and fee, we will notify you of your acceptance to participate in IMS 2001 by e-mail.
Please select your choice of payment from below:@
Bank Name: THE CHIBA BANK, LTD.
Branch Name: CHIBANEWTOWN
Branch Number: 296
Account Name: IMS 2001
Account Number: 3242006
Bank Address: 500, Togami, Inzai, Chiba, 270-1348, JAPAN
VISA and Master Card ONLY. Those who use these credit cards are requested to send the completed Application Form by airmail or Fax (+81-476-46-8027) by April 30, 2001. E-mail is not acceptable.
Until March 31, 2001:
Application fee \30,000- + Commission rateV 2,100- = Total 32,100-
After April 1, 2001:
Application fee \35,000-+ Commission rateV 2,450- = Total 37,450-
@I authorize to be charge the amount due to the following credit card.
VISA@ Master Card
Card holderfs name:
Date of expiration:
Please send money orders by registration airmail. We accept money orders in Japanese Yen only.