Online Pre-Registration Form

This is the Online Pre-Registration Form of the APASL STC on 2018 HCC in Yokohama. Please fill in this form and send to the Congress Secretariat.

Title

Prof. Dr. Mr. Ms.

Name

Affiliation

Position

Department

Postal Address

Postal Code

Country

E-mail Address

Telephone Number

Facsimile Number

Do you have any dietary restrictions?

No Vegetarian Halal

Comment:

Reuse of Personal information

I agree to keep my personal information for receiving future related meetings’ announcement after this event.
I don't agree to keep my personal information for receiving future related meetings’ announcement after this event.

Remarks (if any)

Registration Fee Category (Early Bird Registration until February 28, 2018)

*Following amounts are for Early Bird Registration. Completion of payment until February 28 (Wed) 2018 is required.
APASL Member: ￥15,000 (Membership No. MN- )
Non Member: ￥20,000
Trainee, Resident: ￥10,000 (Required to show certification of status)
Presenting Author: ￥15,000 (Presenter of the accepted Oral/Poster Abstracts)

If you have any accompanying person, please check follows.

Accompanying Person: ￥5,000 (Welcome Reception and Exhibition area entry)

Number of your Accompanying Person

Name of Accompanying Person

Payment Method

Please select your payment way by Credit Card or Bank Transfer.

Credit Card

Please fill in your credit card information below.

Card type

Visa

Master

Amex

JCB

Diners

Card number

Expiration date

/ (month/year)

Holder's name

Security code

(Please input 3-digit number printed on the back of the card.)

Bank Transfer

Please make payment of the amount of your registration fee to the following bank account.

Bank Account Information in English

Bank Name: Mizuho Bank

Branch Name: Shinjuku Branch (Branch No. 240)

Type of Account: Normal

Account Number: 2498962

Account Name: APASL STC Yokohama

Bank Account Information in Japanese

*登録費を以下の指定口座へお振込みください。

銀行名：みずほ銀行支店名：新宿支店(店番240)

口座の種類：普通預金口座番号：2498962

口座名義：APASLシングルトピックカンファレンス横浜

フリガナ：APASLシングルトピツクカンフアレンスヨコハマ

*Please fill in the date you have made (or going to make) bank transfer.
Payment completion is required until 2 weeks after online- registration.
The confirmation of registration will be sent after the payment has been confirmed.

Transfer Date

Year Month Day

Privacy Policy

Please read carefully our policy on the handling of the personal information and consent before proceeding.

Privacy Policy

I agree to the privacy policy.

APASL STC on 2018 HCC in Yokohama
Online Pre-Registration Form

Personal Information

Title

Name

Affiliation

Position

Department

Postal Address

Postal Code

Country

E-mail Address

Telephone Number

Facsimile Number

Do you have any dietary restrictions?

Reuse of Personal information

Remarks (if any)

Registration Fee Category (Early Bird Registration until February 28, 2018)

Payment Method

Please select your payment way by Credit Card or Bank Transfer.

Card type

Card number

Expiration date

Holder's name

Security code

Bank Account Information in English

Bank Account Information in Japanese

Transfer Date

Privacy Policy

Please read carefully our policy on the handling of the personal information and consent before proceeding.

Privacy Policy

APASL STC on 2018 HCC in Yokohama Online Pre-Registration Form

Personal Information

Title

Name

Affiliation

Position

Department

Postal Address

Postal Code

Country

E-mail Address

Telephone Number

Facsimile Number

Do you have any dietary restrictions?

Reuse of Personal information

Remarks (if any)

Registration Fee Category (Early Bird Registration until February 28, 2018)

Payment Method

Please select your payment way by Credit Card or Bank Transfer.

Card type

Card number

Expiration date

Holder's name

Security code

Bank Account Information in English

Bank Account Information in Japanese

Transfer Date

Privacy Policy

Please read carefully our policy on the handling of the personal information and consent before proceeding.

Privacy Policy

APASL STC on 2018 HCC in Yokohama
Online Pre-Registration Form