Payment in Japanese Yen/Registration Form

PAYMENT in Japanese Yen

Advance Registration Deadline
April 25, 2001

Date	Reg. No.	MEMO
/

2001 VLSI Symposia
REGISTRATION FORM

Please complete and return this form to
	Secretariat for VLSI Symposia (Japan) c/o Business Center for Academic Societies Japan 2F, 5-16-9 Honkomagome, Bunkyo-ku, Tokyo 113-8622 JAPAN Tel: +81-3-5814-5800 / Fax: +81-3-5814-5823 / E-mail: vlsisymp@bcasj.or.jp

Please type or print in block letters to avoid trouble.

Prof.

Dr.

Mr.

Ms.

Speaker

Committee

Name:		,
	Family		First	Middle

Affiliation*:

Mailing Address:

Office

Home:

Country

Tel:	+	Fax:	+
	Country Code		Country Code

E-mail:

Accompanying Person(s),
if any:

Registration Fee:

Conference	on or before April 25	On or before May 18 and on-site	Student*
VLSI Technology Short Course	¥ 10,000	¥ 15,000	¥ 5,000
Symposium on VLSI Technology	¥ 45,000	¥ 50,000	¥ 20,000 *
Symposia on VLSI Technology and Circuits	¥ 80,000	¥ 90,000	¥ 25,000 *
VLSI Circuits Short Course	¥ 10,000	¥ 15,000	¥ 5,000
Symposium on VLSI Circuits	¥ 40,000	¥ 45,000	¥ 15,000 *
IWSM	¥ 18,000
Silicon Nanoelectronics Workshop	¥ 20,000	¥ 25,000	¥ 10,000

Grand Total	¥

*Student registration fee does not include dinner. Dinner tickets will be available at the registration desk for an additional fee.
This fee will be applied on or before May 18 and on-site.

Remittance: All payment must be made in Japanese Yen.

I agree to remit the above grand total by following Credit Card:

American Express

VISA

MasterCard

Diners Club

Card number:

Expiration date:

Cardholders's name:

Date:

Authorized Signature:

I have enclosed herewith a bank draft/company check for the above grand total payable to the order of the 2001 VLSI Symposium. Personal checks are not acceptable.

Bank	Branch	Account No.	Account Name
Dai-ichi Kangyo Bank	Hongo (# 075), Tokyo	1161964 (ordinary)	VLSI Symposium

Note: Please send a copy of your bank remittance receipt to avoid mishandling.