ICNP-95 Registration



ICNP-95 Secretariat
c/o Information Processing Society of Japan
Shibaura-Maekawa Building 7F
3-6-20, Shibaura, Minato-ku, Tokyo 108, Japan
Fax: +81-3-5484-3534
Email: icnp95@ipsj.or.jp
Telephone: +81-3-5484-3535

Last/Family First MI Name on Badge
Mailing Address:____________________________________________________
Daytime Phone:__________________ FAX Number:_______________________
Membership (please check appropriate one)
____ 1. IPSJ
____ 2. IEEE
____ 3. ACM
Membership Number:__________________
Do you have any special needs?______________________________________

Please circle appropriate fees:

Total (yen amount) Enclosed:____________________________________

Payment can be made by banktransfer to:

Information Processing Society of Japan
Account No. 046-1013945 Toranomon Branch, Dai-Ichi Kangyo Bank, Ltd.

No perssonal checks are accepted.
Credit cards are accepted only for residents outside Japan.
All payment should be in Japanese yen.

Method of Payment (please check appropriate one)

____ I enclose herewith a bank draft for the fee payable to ICNP-95.
In this case please add handling charge of yen 2,000 to the total amount.
____ I will remit/have remitted the fee on __________________ (date)
under the name of __________________________ (name of remitter)
to the account of ICNP-95.
____ Credit Cards (check one):
___ VISA
___ MasterCard
___ American Express
___ Diners Club

Credit Card Number:__________________________Exp Date:_____________
Cardholder's Full Name:____________________________________________
(Exactly as it is printed on the card)
Amount in Japanese Yen__________________________________
Requests of refunds must be received by the Registration Chair by OCTOBER 11, 1995. Refunds are subject to a 5000 yen processing fee.
All no-show registration will be billed in full. Registrations after OCTOBER 11, 1995 will be accepted on-site only.

Please check if you do not wish your mailing address to be included on:

___Non-Society mailing lists
___Meeting Attendee Lists

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