International conference for Universal design in 2002

If you would like to reserve online, please fill in this form.
You can register also mail, or Fax. print out this form, fill it out, and send it via postal service to UD2002.

*Please use each form per each attendee.

I would like to register UD2002 conference as follows after reading registration policy.

Name Mandatory Given name Family name

Affiliation

Sex Mr. Ms.

Adress

Please select mandatory Home Office

*We will send invoice to registered postal address, FAX, or E-mail.

Zip code mandatory (Sample:1234567)

Adress mandatory

Telephone Number (Sample:0000000000)

Fax Number (Sample:0000000000)

e-mail
Mandatory for registered online

Preregistration

Please select Mandatory Non Student Student Accompanied

Date  Mandatory

Full Conference

Nov. 30    Dec. 1    Dec. 2    Dec. 3    Dec. 4

  Total   YEN
  *525 yen is added to the registration fees above as a registration handling fee.

Agreement

Do you agree with agreement? Mandatory Agree

Method for Payment

Please select Mandatory
Credit Card

Bank transfer after invoice

Please fill information if you select credit card.

We accept
VISA Master JCB AMEX Diners

Card number

Expiration Date Year Month

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Sending address for FAX and postal service
UD2002, JTB Corp. Totsuka branch
481-1 Kamikurata-chou, Totsuka-ku
Yokohama city, Kanagawa 244-0861
Japan
Fax?F +81-45-864-4767
UD2002, Totsuka Branch, JTB Corp.