< PAYMENT in Japanese Yen >

Early Registration Deadline    April 25, 2003
Late Registration Deadline     May 16, 2003


Date Reg. No. MEMO
/    

2003 VLSI Symposia
REGISTRATION FORM

Please register online at /16web if at all possible. Otherwise, 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:

Registration Fee:

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
Grand Total ¥
*Student registration fee does not include dinner. Dinner tickets will be available at the registration desk for an additional fee.


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 VLSI Symposium. Personal checks are not acceptable.

[  ]   

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:
On or before May 16 Cancellation fee, ¥5,000 will be deducted before refunding the fee.
After May 16 No refund. A copy of the digest will be sent after the symposium.