< PAYMENT in Japanese Yen > |
Early Registration Deadline April 25, 2003
Late Registration Deadline May 16, 2003 |
|
|
|
2003 VLSI Symposia
REGISTRATION FORM
Please register online at /20web 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 |
|
Mailing Address:
[ ] Office
[ ] Home: |
|
|
Country |
Tel: |
+
|
Fax: |
+
|
|
Country Code |
|
Country Code |
E-mail: |
|
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. |
|