KJMW2011 Registration Form Name:______________________________________________________ Affiliation:_______________________________________________ Address:___________________________________________________ ___________________________________________________________ Country:___________________________________________________ E-mail or Tel.: ___________________________________________ ----------------------------------------------------------- Are you a Speaker? [ Yes / No ] Paper ID: ____________________ Session Chair? [ Yes / No ] Session ID: __________________ Member of KJMW2011 committee? [ Yes / No ] ----------------------------------------------------------- Please check one: Registration Type: [ ] Member (IEEE / IEICE / KIEES): 12,000 yen Please write membership ID. IEEE / IEICE / KIEES #____________________ [ ] Regular (Non-menber): 15,000 yen [ ] Student: 5,000 yen Student registrants must bring their valid student ID or any official letter from your school to show your current student status. KJMW2011 Registration Team may ask you to show your ID at our registration desk. Failed to show your student status, you may be asked to pay a regular (or member) fee. ------------------------------------------------------------- Please fill in all the necessary items on this form, and send it to "maruhashi**ieee.org" ASAP. (Please replace ** with @ when you send an e-mail)