Registration

Please complete this form to sign up for your participation to MISASA-IV and click “Submit” below the form. This form will be sent to our organizing committee who will contact you to confirm details of the travel itinerary, scientific program, and travel support after registration closing date. We require a registration fee of 10,000 JPY for each participant. This covers welcome party, lunch boxes, coffee, and banquet. We might help to accommodate specific requests regarding food allergies. Please let us know if you have any concerns. A deadline of the registration is January 23, 2012. Online submission of an abstract is also available from here, and a deadline of the submission is February 15, 2012.

Name (required):
First:
Middle:
Last:
ProfessionalStudent
(Number of accompanying person: )

Affiliation:

Email adress (required):

Address:
Street:
City:
State/Province:
Country:
Zip/Postal Code:
Telephone:
Fax:

Presentation:
PosterInvited talk (OS: )
Presentation title:

Accommodation:
February 23 (Thu.)
February 24 (Fri.)
February 25 (Sat.)
February 26 (Sun.)
February 27 (Mon.)

Note: Hotel St. Palace Kurayoshi, which is located in front of the JR Kurayoshi Station, will be made arrangements. Ice break party and banquet will be held in the same place. We offer a shuttle bus service from the hotel to the conference place.

Travel support request:
Note: If you need travel support, please check this. We will contact you later.

Comment and questions:

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Private information in this form shall be used for the international symposium, MISASA-IV.

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