SICE Annual Conference 2003 in Fukui Registration Form

DeadLine for advance registration: June 30, 2003
Please fill out this form and push the send button.
Please do not include 2-byte characters in any field.
Name:(*last/family name)
(*first name)
(middle name/initial)
Title:
*Sex:
Affiliation:
(University/Company)
*Mailing address:
Name,
Dept.,
University/Company,
address,
City/State/Zip/Country
*Country:
*Phone:
Fax:
*E-mail:
*Society membership:
 Member ID:
Paper ID (if presenter):
Session Chair:
Session ID:
Information on the name tag:
         Title:
     Name:
Affiliation:
*Registration:
(include 1 CD-ROM)
Extra Proceedings:
(CD-ROM)
 Quantity
Banquet:

Dietary requirements (e.g. vegetarian):

Name of your family who accompanies to Banquet:
Total Extra Page Charge
(no charge: up to 6, maximum: 8 for 1 paper)
 10,000JPY x
Technical & Social Tour:
 person(s),
name(s) of participant(s):
Dietary requirements (e.g. vegetarian):
*Payment:

Bank Transfer
Total fee was paid to the A/C No.108600 (The Society of Instrument and Control Engineers), The UFJ Bank Ltd., Hongo Branch, Hongo 3-33-5, Bunkyo-ku, Tokyo 113-0033, Japan through
(name of bank) on (date) .
Credit Card
Submission of this form is secure by SSL protocol. However, if you do not wish to send the credit card information on-line, please fax it using the credit card payment form included in the confirmation email to be sent to you after submitting this registration form. Even if you do not wish to send the card information on-line, please select at least Card Type.
Card Type:

Card number: --- Exp. Date: / (MM/YY)

Name of card holder

Request to Registration Desk:
  If you have any question, please write to sice2003_reg@sice.or.jp.
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