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: