REGISTRATON AND HOTEL APPLICATION FORM

12th International Conference on Domain Decomposition Methods

October 25-29,1999

Chiba University Chiba, Japan

Return this

DD12 DESK

 

 

form to:

Nippon Travel Agency Co., Ltd., International Travel Dept.

TEL:

+81-3-3572-8743

 

3rd Fl. Shimbashi Ekimae Bldg. #1, 2-20-15

FAX:

+81-3-3572-8689

 

Shimbashi, Minato-ku, Tokyo 105-8606 Japan

E-mail:

  

Attention:

Mr. Ezawa / Ms. Hidaka

convention_itd@nta.co.jp

 APPLICANT □Prof. □Dr. □Mr. □ Ms.

Last name:

 

Given name:

 

Phone:

 

Fax:

 

E-mail:

 

Country:

 

Mailing address: (for correspondence) □ Office □ Home

 

 

 

Company or University:

 

1. REGISTRATION FEE

 

Category

Early / Late

Fee

□

Academics and Industrialists

on / before 31 Aug.

JPY 26,000

□

Academics and Industrialists

on / after 01 Sep.

JPY 30,000

□

Full time students

on / before 31 Aug.

JPY 13,000

□

Full time students

on / after 01 Sep.

JPY 15,000

□

Accompanying person

on / before 31 Aug.

JPY 10,000

□

Accompanying person

on / after 01 Sep.

JPY 12,000

2. HOTEL ACCOMMODATIONS

Choose hotels from the attached list. Please use one sheet for each request.

Hotel Choice

Room Type

Check-in Date

Check-out Date

Number of Nights

Total Amount

1st

 

 

 

 

 

2nd

If twin, sharing with:

*Cancellation charge will be required after your application. Please refer to the attached information.

3. NIKKO TOUR

Date

Fare

Num. Of Person(s)

Amount

27 October

JPY 7,000

 

 

4. PAYMENT:

□ Credit Card :

□American Express / □Visa / □Master / □Diners Club

Card Number:

 

Valid thru:

 

Card Holder:

 

Date:

 

Authorized Signature:

 

□ Payment by bank transfer to:

Bank Name :

Tokai Bank Ltd. Shimbashi Branch

Account No.:

1053199

Account Name:

Nippon Travel Agency

Please send a copy of the bank transfer record after payment is completed.