Registration Form

Registration fees:

Category PPNC
only
Mt. BANDAI
only
Participate in both Fee
Physicians JPY30,000 JPY30,000 JPY50,000 JPY
Residents, Fellows, Nurses, Medical Engineer, Rehabilitaion etc JPY20,000 JPY20,000 JPY30,000
Accompanying Person JPY10,000 x JPY
Accompanying Children JPY0 x JPY
Banquet
PPNC January 30 (The) JPY0 x JPY
Mt. Bandai Febrauary 2 (Fri) JPY0 x JPY
Golf Tournament
"Pan-Pacific Cup"
January 30 (Tue)
Golf Fee JPY24,000 x
Club Rentals JPY6,000 x
JPY
JPY
"Mt. BANDAI Cup"
February 2 (Fri)
Golf Fee JPY18,000 x
Club Rentals JPY5,000 x
JPY
JPY
Total Fee JPY

Participant Information:

Title
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

Accompany person Information:

**Spouse/Accompany 1 Information **
Title
Family Name
First & Middle Name
Relationship
**Spouse/Accompany 2 Information **
Title
Family Name
First & Middle Name
Relationship
**Spouse/Accompany 3 Information **
Title
Family Name
First & Middle Name
Relationship
**Spouse/Accompany 4 Information **
Title
Family Name
First & Middle Name
Relationship

Payment Information:

Payment Credit Card
 

Please note that additional charges may occur due to fluctuations in the exchange rate and so on.

  • ** Cancellation Policy**
  • Congress Registration
  • * The deadline of your congress registration cancellation is Dec.20.2017 (Wed, Tokyo time).
  • * The cancellation must be requested by writing via fax or email to the congress coordinator.
  • * The cancellation will not be complete without the written notice from the congress coordinator.
  • * Please note that you will not receive your refund if any cancellation is made after this date.
  • Golf Registration
  • * 80% of total golf fee will be refunded if you request the cancellation before Dec.19.2017 (Tue, Tokyo time).
  • * Non-refunded if you request the cancellation after Dec.20.2017 (Tue, Tokyo time).
  • * The cancellation must be requested by writing via fax or email to the congress coordinator.
  • * The cancellation will not be complete without the written notice from the congress coordinator.
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