Registration Form

Category	After December 1, 2018 and On-site	Fee
Physician	50,000 JPY	JPY
Accompanying Person	5,000 JPY x 0 1 2	JPY
Accompanying Children * under 15 yrs old	0 JPY x 0 1 2 3	JPY
Welcome Reception (Tue. Jan 15)	0 JPY x 0 1 2 3 4	JPY
Farewell Party (Fri. Jan 18)	0 JPY x 0 1 2 3 4	JPY
Ski Race (Fri. Jan 18)	0 JPY x 0 1 2 3 4	JPY
Total Fee		JPY

Participant Information:

Title	Prof. Dr. Mr. Mrs. Miss.
Family Name
First & Middle Name
Affiliation
Street Address
City and State
Zip Code
Country
Phone	*Please start from your country code.
Fax	*Please start from your country code.
E-Mail

Accompanying person Information:

**Accompanying Person 1 Information **
Title	Mr. Mrs. Miss.
Family Name
First & Middle Name
Relationship
**Accompanying Person 2 Information **
Title	Mr. Mrs. Miss.
Family Name
First & Middle Name
Relationship

Payment Information:

Payment

Credit Card

REMARKS:

Online registration will be closed on December 31, 2018. Any registration after January 1, 2019 will be done on-site.

* We accept only credit card for pre-registration.

* Cash or Bank transfer will NOT be accepted for your pre-registration.

* The registration will be confirmed only when your payment is completed properly.

* The registration confirmation will be sent by email once your payment is confirmed.
*Children under 15 years old are free of charge.

CANCELLATION:

* The deadline of your registration cancellation is Friday, December 14, 23:59 (Tokyo time).

* The cancellation must be requested by writing via fax or email to the congress coordinator.
(Email: inwc2019-office@umin.ac.jp , FAX. +81-3-5289-8117)

* The cancellation will not be complete without the written notice from the congress coordinator.

* Your registration fee will be full-refunded if you request the cancellation by this date.

* Please note that you will not receive your refund if any cancellation is made after this date.