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.