Dead line: October 11, 2011

SSS'11 Advanced Registration Form
E-mail or Fax to: Yukihiro KUBO, SSS'11 Secretary, E-mail: sss11@sci-sss.org, Fax: +81-77-561-2663

Corresponding Address
Note: The proceeding CD-ROM(s) will be sent to the corresponding address.
If you have a specific request on the delivering of CD-ROM(s), please give details by E-mail.

Title(If you are a resident in Japan, please give your Address (and Name) also in Japanese)

NameAddress
Phone
FAX
E-mailRegistrations
Registrants Title

Name

Affiliation

Type of registration12345
Subtotal of registrations:

JPY

Options
Note: One proceedings CD-ROM and one banquet ticket are included in Full Registration.
Optional Proceedings CD-ROM

5,000JPY eachX

Quantity:=

JPY

Optional Banquet Ticket

6,000JPY eachX

Quantity:=

JPY

Subtotal of options:

JPY

Accommodations
Rooms

Name

Accompany person'sname(twin)

Accommodation Plan
Oct. 27

Oct. 28

Oct. 29

12345

Subtotal of accommodations:

JPY

TOTAL:JPY

To participants of banquet and guests of hotels:
Do you have any food restrictions?

NOYES,(if YES, please detail your restrictions)Bank Transfer Information
Amount of remittanceName of remitter
Completed or expected date ofremittance

JPY(MEMO)

Dead line: October 11, 2011

SSS'11 Advanced Registration Form
E-mail or Fax to: Yukihiro KUBO, SSS'11 Secretary, E-mail: sss11@sci-sss.org, Fax: +81-77-561-2663

Corresponding Address
Note: The proceeding CD-ROM(s) will be sent to the corresponding address.
If you have a specific request on the delivering of CD-ROM(s), please give details by E-mail.

TitleProf.

NameTaro Ritsumei

立命 太郎AddressDepartment of Electrical and Electronic Engineering, Ritsumeikan University,
1-1-1, Noji-Higashi, Kusatsu City, SHIGA 525-8577 JAPAN525-8577 滋賀県草津市野路東1-1-1 立命館大学理工学部電気電子工学科

Phone+81-77-561-XXXX

FAX+81-77-561-YYYY

E-mailaaaa@bbb.com(If you are a resident in Japan, please give your Address (and Name) also in Japanese)

Registrations
Registrants Title

Name

Affiliation

Type of registration

1Prof.

Taro Ritsumei

Ritsumeikan university

Full Reg.(member): 22,000JPY

2Mr.

Ichiro Ritsumei

Ritsumeikan university

Student Reg.: 5,000JPY

345
Subtotal of registrations:

27,000JPY

Options
Note: One proceedings CD-ROM and one banquet ticket are included in Full Registration.
Optional Proceedings CD-ROM

5,000JPY eachX

Quantity:

1=5,000

JPY

Optional Banquet Ticket

6,000JPY eachX

Quantity:

1=6,000

JPY

Subtotal of options:

11,000JPY

Accommodations
Rooms

Name

1

Taro Ritsumei

2

Ichiro Ritsumei

Accompany person'sname(twin)

Accommodation Plan
Oct. 27

Oct. 28

Oct. 29

Biwako Hotel (single, Non-Smoking):
8,000JPY
Biwako Hotel (single, Smoking):
8,000JPY

Bianca (single, Non-Smoking):
8,000JPY
Biwako Hotel (single, Smoking):
8,000JPY

Epoch Ritsumei 21(single, NonSmoking): 4,000JPY
Epoch Ritsumei 21(single, NonSmoking): 4,000JPY

345

Subtotal of accommodations:

40,000JPY

TOTAL:

78,000JPY

To participants of banquet and guests of hotels:
Do you have any food restrictions?

X

NO
YES,

(if YES, please detail your restrictions)Bank Transfer Information
Amount of remittance

78,000Name of remitter

Taro Ritsumei

Completed or expected date ofremittanceOct. 1, 2011

JPY(MEMO)This is a sample.