Online registration form

Thank you for your interest. To register for 4th APG Symposium & 9th EADC please fill out the form below.
The fields marked * are compulsory.

DELEGATE’S INFORMATION
Prefix *	Mr.　Ms.(Mrs.)　Prof.　Dr.
Given Name *
Family Name *
Organization/Company *
Position/Job title *
Postal Address *
City
State/Province
Zip/Postal code *
Country *
Phone *
Fax
Email address *

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Nationality
Passport No. *
Dietary requirements *	a. None b. Vegetarian (only vegetables) c. Vegetarian (vegetables and sea foods) d. Halal e. Others (please specify your dietary requirements)
I agree to the publication of my name, nationality and company in the List of Participants on the 4th APG Symposium and 9th EADC Website. * Yes No
REGISTRATION DETAILS (The registration fee are payable in JPY.)
Delegate	¥60,000
Accompanying persons	¥30,000 / person person(1〜3)
Accompanying persons must be a family member. 1. Given Name Family Name Passport No Gender Male    Female 2. Given Name Family Name Passport No Gender Male    Female 3. Given Name Family Name Passport No Gender Male    Female
Technical Tour	¥25,000 / person Attend person(1〜4)
T-1 Half day City tour	person(1〜4)
S-1 Welcome reception	person(1〜4)
S-2 Farewell Banquet	person(1〜4)

HOTEL RESERVATIONS You can make a hotel reservation on this site. Royton Sapporo Hotel, they have twinrooms only.

Date of Check in Date of Check out night rooms (1〜3) room1 smoking_type * non-smoking   smoking use * Choose use Single Use ¥15,000 Double Use ¥20,000 Triple Use ¥27,000 room2 smoking_type * non-smoking   smoking use * Choose use Single Use ¥15,000 Double Use ¥20,000 Triple Use ¥27,000 room3 smoking_type * non-smoking   smoking use * Choose use Single Use ¥15,000 Double Use ¥20,000 Triple Use ¥27,000

TOTAL AMOUNT All payments shall be made in Japanese Yen (JPY) by bank transfer. All currency exchange charges and bank fees are the responsibility of the remitter.
TOTAL AMOUNT (provisional)

ARRIVAL ― DEPARTURE Will inform later Arrival Details in Chitose Air Port Origin Airport Airline Flight No. Date Time Departure Details from Chitose Air Port Airline Flight No. Date Time

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