Those who use credit cards are requested to send the completed registration form by air mail or facsimile because your signature is required in the credit card section of the form. Please do not apply by e-mail.

pdf file of registration form :

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BIO-ROBOTICS II
Southern Osaka Industrial Promotion Center, Sakai, Osaka, Japan
November 25-26, 2000
Deadline : September 29, 2000

Registration Form

Please type or fill out in block letters and send this form to BIO-ROBOTICS II secretariat:
Dr. Mitsuji Monta
Faculty of Agriculture, Okayama University
1-1-1 Tsushima-naka, Okayama 700-8530, JAPAN
Fax : +81-86-251-8388 (086-251-8388 for domestic call)
E-mail : monta@ccews2.cc.okayama-u.ac.jp

I. Workshop

1. Participant Name (Check one) : Prof., Dr., Mr., Ms.
(Family Name) (Given Name) (Middle Name) :

2. Affiliation (University, Company, etc.)

3. Title / Position :

4. Mailing Address (Check) : Office, Home
City :_____________________________ State / Province : _____________________________
Zip Code : ________________________ Country : _____________________________
Tel : _____________________________ Fax : _____________________________
E-mail : __________________________________________________________

5. Name(s) of Accompanying Person(s) : Mr., Ms. (Check)
(Family Name) (Given Name) (Middle Name) :

6. Registration Fee

II. Hotel Reservation

Room Type : Single (10,500 Yen per person) : (___)room(s) x (___) night(s)
Twin (18,000 Yen per room) : (___)room(s) x (___)night(s)

Period of Stay : Check-in : _______________ Check-out : _______________
* Breakfast, tax and service charge are included.

Advance registration (On or before 31 August, 2000) only
( ) I would like to use Gift Coupon (See 'Registration Information').
Deduction : - 10,500 Yen for single room, - 18,000 Yen for twin room

III. Method of Payment

* Please check the method and fill in the blanks as possible.

Bank transfer

I have remitted the above sum of ____________________________ Yen bybank transfer by the name of
_____________________________ _____________________________________________(your name) through
my bank ___________________________________________________________________(name of your bank) to :

Name of Bank : Sanwa Bank Ltd., Komyoike Branch
Account No. : 5037034
Account Name : BIOROBOTICS

*Please enclose a copy of your bank's receipt with this form to avoid the possible confusion.

Credit card : VISA, Master Card

Card No. :
Expiration Date : _____________________(month) / _____________________(Year)
Name of the card holder (Please print) :

Signature : _____________________Date : _____________________