| < PAYMENT in Japanese Yen > |
Early Registration Deadline April 25, 2003
Late Registration Deadline May 16, 2003 |
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2003 VLSI Symposia
REGISTRATION FORM
| Please register online at /16web if at all possible. Otherwise, complete and return this form to |
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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: |
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Family |
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First |
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Middle |
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| Mailing Address:
[ ] Office
[ ] Home: |
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Country |
Tel: |
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Fax: |
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Country Code |
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Country Code |
E-mail: |
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Conference |
on or before
April 25 |
On or before May 16
and on-site |
Student*
On or before May 16
and on-site |
| VLSI Technology Short Course |
[ ] ¥ 15,000 |
[ ] ¥ 20,000 |
[ ] ¥ 5,000 |
| Symposium on VLSI Technology |
[ ] ¥ 50,000 |
[ ] ¥ 55,000 |
[ ] ¥ 20,000 * |
| Symposia on VLSI Technology and Circuits |
[ ] ¥ 95,000 |
[ ] ¥ 105,000 |
[ ] ¥ 30,000 * |
| VLSI Circuits Short Course |
[ ] ¥ 20,000 |
[ ] ¥ 25,000 |
[ ] ¥ 5,000 |
| Symposium on VLSI Circuits |
[ ] ¥ 50,000 |
[ ] ¥ 55,000 |
[ ] ¥ 20,000 * |
| Silicon Nanoelectronics Workshop |
[ ] ¥ 20,000 |
[ ] ¥ 25,000 |
[ ] ¥ 10,000 |
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| Grand Total |
¥ |
*Student registration fee does not include dinner. Dinner tickets will be available at the registration desk for an additional fee.
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| Remittance: All payment must be made in Japanese Yen. |
| [ ] I agree to remit the above grand total by following Credit Card: |
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[ ] American Express [ ] VISA [ ] MasterCard [ ] Diners Club |
| Card number: |
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Expiration date: |
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| Cardholders's name: |
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| Date: |
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Authorized Signature: |
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I have enclosed herewith a bank draft/company check for the above grand total payable to the order of VLSI Symposium.
Personal checks are not acceptable.
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| Bank |
Branch |
Account No. |
Account Name |
| Mizuho Bank |
Hongo (# 075), Tokyo |
1161964 (ordinary) |
VLSI Symposium |
| Note:Please send a copy of your bank remittance receipt to avoid mishandling. |
| Cancellation:If written notice of cancellation reaches the Japanese Secretariat: |
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On or before May 16 |
Cancellation fee, ¥5,000 will be deducted before refunding the fee. |
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After May 16 |
No refund. A copy of the digest will be sent after the symposium. |
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