ISMVL-2003 Registration Form

First name: ______________________________ Middle name(s): ____________________
Family name: ______________________________ Title [Prof., Dr., Mr., Ms., etc.]: __________
Address (Please write details, make sure that mail can reach you at the address you provide)
_____________________________________________________________________________
_____________________________________________________________________________
Phone:_____________________ FAX:_____________________ E-mail: __________________

(1) Registration fee

	Before April 16, 2003	After April 16, 2003
IEEE Member	35,000 Yen or $270	42,000 Yen or $330
Non-member	45,000 Yen or $340	54,000 Yen or $410
Student	10,000 Yen or $80	15,000 Yen or $120

Student rates apply to full-time students, as well as to retired people who are at least 62 years old and are not employed full-time.

(3) $50 annual subscription to J. for Multiple Valued Logic and Soft Computing (optional)

PAYMENT: [Check either of the boxes]

I will remit/have remitted the fee on ___________________ [date]
under the name of _________________________________ [name of remitter]
to the Bank of Tokyo-Mitsubishi, Jiyuugaoka-branch, Tachironri Kikin
Mukaidono Masao, Account number 1298956
I enclose a US dollar check payable to Masao Mukaidono
Credit Card: VISA or MasterCard [check one]
Card Number: ____________________________ Exp. date_____/_____/_____
Name as it appears on the card:_______________________________________

Signature:

Date: _____________________________________

Fill out, sign and mail this form to Prof. Yutaka Hata, Registration Chair or send it by either
FAX: (+81) 792-66-8868, or E-mail: hata@ieee.org and takagi@pu-toyama.ac.jp.
Forwarding address and more information can be found on the Symposium website http://science.icu.ac.jp/ismvl/

NOTES: For your security, do not send your Credit Card information by email (use fax or mail instead).
Please send us a copy of your bank remittance receipt to avoid possible delays.
All on-site payments, including on-site registration will be accepted in Japanese cash only.
Confirmation and a receipt will be sent to you after your payment has been received.