The 5th PASREG 2005 Registration form
Please fill out all fields marked with '*'.
*Title: Prof.   Dr.   Mr.   Ms.
*Family Name:
Middle Initial:
*First Name:
*Zip Code: *Country:
*Phone: Country Code  Phone Number
Fax: Country Code  Fax Number

Accompanying Person(s) if any
Family Name:
Middle Initial:
First Name:
Family Name:
Middle Initial:
First Name:

Fee (Payments can be made by Japanese yen , U.S dollars. or Euro)
Registration Fee: ¥ 20,000 $ 150 Euro 120
We do not accept credit cards. Please pay the registration fee in cash at the registration desk on site. The registration desk will be open from am8:00 - pm8:00 on October 21 and am8:00 - pm7:00 on October 22.

After completing this form, please click [submit] button.

If you don't make registration, go back to Top page.