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Online Registration Form

Japan time FRI Jul.1 9:33:2 (UTC+9:00)

     *If you are a First Time User of this system, please fill out “Personal Information” to start your registration.
     *After you complete your registration, a Registration ID and password will be emailed to you.
     *To change your registration, please enter your Registration ID and Password to log in to the site.
 Registration ID   
 Password    

  Personal Information

Participant
Title*
Prof.  Dr.  Mr.  Ms.
First Name*
(e.g. John)
Middle Initial
(e.g. K)
Last Name*
(e.g. Smith)
Gender*
Male  Female
Mailing Address*
Office  Home
Affiliation*
Position*
Street*
City/State/Prefecture*
Postal Code*
Country*
Phone Number*

ex: +81-3-xxxx-xxxx (Country code-area code-local number)
Fax Number

ex: +81-3-xxxx-xxxx (Country code-area code-local number)
E-mail Address*

Please retype the same E-mail address.

  Registration

* All fees are in Japanese Yen
* Registration fee includes: Abstract Collection, Welcome Party, Banquet, Coffee Break

Early Registration
(On before August 31)
Late Registration
(On before October 24)
Onsite Registration
(After November 7)
Full Registration
(Includes Banquet)
JPY 50,000
JPY 60,000
JPY 65,000
Student
(Includes Banquet)
JPY 30,000
JPY 35,000
JPY 40,000
Student
(Excludes Banquet)
JPY 20,000
JPY 25,000
JPY 30,000
Accompanying Person
 0 person
Accompanying person
(Includes Banquet)
JPY 10,000
JPY 10,000
JPY 10,000
Title
Prof.  Dr.  Mr.  Ms.
First Name
Last Name
Remittance
VISA/Master
Card Number*
Enter your 14-16 digit card number without spaces or dashes.
Credit Card Holder*
Expiry Date (Month/Year)* / ※ 08 / 2018
Please enter a valid credit card until November 10,
Security Code*
The last 3-4 digits on the reverse side of the card

Cancellation fee
* In case of Cancellation, your registration fee will be refund after deducting the cancellation fees as follows.
*Please cancel your registration by logging-in to your Personal Page.
After payment until October 7, 2016    10% of the registration fee
On or After October 8, 2016        100% of the registration fee/No-Refund

Entry Visa of Japan*
need  do NOT need
* Please examine whether the visa of Japan is required.
http://www.mofa.go.jp/j_info/visit/visa/short/novisa.html
Special food request
Vegetarian  Halar for Muslim  Antiallergic food  Others 
Please fill in if you chose others
 

Registration Form Sample

Visit
Win-Aoyama, 2-2-15
Minami-aoyama, Tokyo,
107-0062
Call
Phone: 81-3-3403-0071
Fax: 81-3-3403-0061
Contact
Copyright
2014 by
Academia Tours, Inc.