| INAP'2001 REGISTRATION
Please complete the following form and send by fax or email to:
INAP
REN Associates, Inc.
#302, 3-17-42 Shimo-ochiai, Shinjuku-ku, Tokyo 161-0033, Japan
Phone +81-3-3950-1641 Fax +81-3-3565-7717
ren-net@tc.xdsl.ne.jp
Name:
Company/Univ.:
Department:
Address:
City:
Country:
Phone:
Fax:
Email:
Conference Registration INAP2001
[ ] Regular registration Yen35,000
[ ] Student registration Yen12,000
Method of Payment
[ ] Bank transfer. Please send invoice.
[ ] Credit card
[ ]Master [ ]Visa [ ]Diners [ ]Amex
Card number:
Cardholder name:
Expiration date:
Total amount: Yen[ ]
[ ] on-site cash payment
Signature:
Comments/Requests:
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