WORKSHOP REGISTRATION FORM                  
           for PKC'99, 1-3 Mar. 1999, Kamakura, Japan         

 
Title:     [ ] Prof / [ ] Dr / [ ] Mr / [ ] Ms

Last Name:   _______________________________________________________

First Name:  _______________________________________________________

Affiliation: _______________________________________________________

Mailing Address: ___________________________________________________


Phone:  __________________________ Fax: ____________________________

E-Mail: ____________________________________________________________

Contributor of a paper:                          [ ]Yes / [ ]No

Number of accompanying persons who will be attending:
   the reception on 1 Mar. 1998    _________ person(s)(5000Yen per ticket) 
   the banquet   on 2 Mar. 1998    _________ person(s)(8000Yen per ticket)

Workshop Registration Fee:             25,000Yen
*Registration fees cover the reception, banquet and proceedings.

Method of Payments:
  Workshop registration fees must be paid in Japanese Yen
  to the following PKC'99 bank account via Bank Transfer:

     Bank Name:      Dai-ichi Kangyo Bank
     Branch:         Roppongi
     Address:        7-15-7 Roppongi, Minato-ku, Tokyo 106-8558
     Account Number: 053 2023386
     Account Name:   PKC'99

Date: _____________________ Signature: _____________________________

Post/Fax                          |
 (1) the completed form, and      |
 (2) a copy of remittance receipt |For More Information:
to the following address:         |
  PKC'99 Secretaliat              | Phone: +81 3 3402 6231 ext. 2327
  Imai-Lab, the Third Department  | Fax:   +81 3 3402 7365
  Institute of Industrial Science | E-mail:
  The University of Tokyo        /   pkc99@imailab.iis.u-tokyo.ac.jp
  7-22-1 Roppongi, Minato-ku    /URL:
  Tokyo 106-8558, JAPAN        /http://hideki.iis.u-tokyo.ac.jp/pkc99/

Notes:
  1.Please complete the form in English only.

---- (Below is for Secretariat use only. Please do not fill in.) ----
     check:  1____   2____   3____     Comments: