登録フォームの登録登録登録登録フォームをおる。おいしてお登録い下おをみくださいくださいしいくださいください個人情報の取扱いについて Registration Form登録フォーム International Conference of World Federation of Acupuncture-Moxibustion Societies Tokyo/Tsukuba 2016(WFAS Tokyo/Tsukuba 2016) How We Handle Personal Information WFAS Tokyo/Tsukuba 2016- 個人情報の取扱いについて * Please make sure to read and agree the following before starting the registration.参加登録を始める前以下をお読みいただき同意してください。 We, WFAS Tokyo/Tsukuba 2016 Local Organizing Committee (hereinafter the "Conference"), are committed to protect the personal information of the applicants based on the Act on the Protection of Personal Information (personal information protection law in Japan), and shall handle the personal information collected through this registration form as mentioned below. 以下いいるき参加を以下おいしめてお。 The personal information that you submit through this form will be used in such cases as the following: おした下いたし。 - To operate and manage the Conference - To contact you to carry forward your registration procedure 参加登録るお - To provide the information of this Conference and other related conferences る - When we may need to contact you by some other reasons をる For smooth operation of the Conference, we are entrusting the operation of collecting, storing, managing and handling personal information regarding the Conference to the following company, who will act as the Secretariat and Registration Office under a confidentiality agreement. をめるためいてをした下してい。 In case there is an error in your personal information collected for the Conference, please inform the Registration Office to have it corrected or deleted 加る登録ください。 Offering personal information is voluntary, but please note without offering the necessary information, you are unable to attend the Conference. さい参加いただくください。意 We do not use cookies and/or web beacons to acquire any personal information. してお。 Contact Information of the Registration Office Managing the Personal Information に個人情報 JTB Communication Design，Inc.(former ICS Convention Design, Inc.) Convention Department 2, Meeting & Convention Business Unit Attn: Koji Sasagawa (Department Manager) Celestine Shiba Mitsui Bldg. 3-23-1, Shiba，Minato-ku，Tokyo 105-8335, Japan Phone: +81-3-5657-0777 Administrators of Personal Information Collected for the Conference の個人情報に Ikuro Wakayama Secretary General of WFAS Tokyo/Tsukuba 2016 Local Organizing Committee The Japan Society of Acupuncture and Moxibustion (JSAM) I agree with the above-mentioned matter and register for the Conference. にの登録い next チェックを入れる個人情報の取扱いについてにててい登録フォーム個人情報 Registration Form 登録フォーム Please fill in the form in English; てください - complete all lines hereunder marked with * (mandatory field). いた - fill in one form per participant. 参加き登録 - type the first letter of each word in capital letter. してください - use ASCII Code only: A to Z, a to z, 0 to 9, and : ! , " , # , $ , % , & , ' , ( , ) , ~ , * , < , > , ? , _ , - , { , } , + , * and ^ をください System Requirements (recommended) OS: Windows Vista or later version, Mac OS X Browser:Windows: Microsoft Internet Explorer 9 or later version, FireFox3, Chrome Mac OS X: Safari5, FireFox3 2016 2016 Deadline for Early Registration: July 7, 2016 Deadline for Late Registration: October 20, 2016 て * All Deadlines are in Japan Standard Time. 10 20 Participant ＊が必須 Title * Family Name * Given Name * ●Prof. Dr. Mr. Ms. Yamada Taro 山田太郎 Middle Name Affiliation * ABC company ABC社 Department 以下を使うと簡単です！日本語住所の英語表記変換サービス http://judress.tsukuenoue.com/ Position Contact * Street * City * Prefecture/State/Province/Region ZIP/Postal Code * Country * Phone * ● Office Home Celestine Shiba Mitsui Bldg. 3-23-1 Shiba 芝3-23-1 セレスティン芝三井ビルディング港区 Minato-ku 東京都 Tokyo 105-8335 携帯電話の場合 090-1234-5678 Japan e.g.) 81-3-1111-2222 03-1111-2222 の e.g.) 81-3-3333-4444 FAX e-mail * e-mail * Your Membership (if any) JSAM Membershp No. wfas2016-reg@@jtbcom.co.jp （81） /FA の「賛助会員」団体所属の方も日本伝統鍼灸学会会員として参加登録できます Please fill in again to confirm wfas2016-reg@@jtbcom.co.jp を To apply for the member rate, please select the society/societies you belong to. JSAM ●JTAMS Both JSAM and JTAMS をおい If you are a member of JSAM, please fill in the four-digit number informed by JSAM. をしてください。期限(7/7)に注意！ Fee EARLY REGISTRATION い (Until July 7, 2016) Regular ● Member(JSAM/JTAMS) Student Post Conference (Practical Training Session in a small group) on November 7 at Tokyo て Gala Dinner on November 5 LATE REGISTRATION い (From July 8, 2016) JPY50,000 5万円 JPY60,000 JPY30,000 3万円 JPY40,000 JPY10,000 1万円 JPY10,000 EARLY REGISTRATION い (Until July 7, 2016) LATE REGISTRATION い (From July 8, 2016) JPY20,000 2万円 JPY30,000 0 person 人 JPY10,000 1万円 JPY10,000 0 person 人日本らしさを演出する楽しい懇親会！ next 個人情報ていください。ておした登録フォームー情報 Registration Form 登録フォーム Payment Information い情報ー情報の取扱いについて [How we handle your credit card information] ICS Convention Design, Inc. will use the credit card information provided through this form as follows: したをおいいたしー情報の取 Name of Collector of Credit Card Data ICS Convention Design, Inc. Outsourcing of Payment Processing の ICS Convention Design, Inc. consigns all operations necessary to process payments for the registration fee by credit card to JTB BUSINESS INNOVATORS Corp. をしたいたし Retention Period The credit card data is saved for 6 month, after which it is erased. おしたしたさていただき。チェックを入れるいて同意る I agree with the above-mentioned matter. *If the credit card holder name differs from that of the participant, the payment may be canceled by the Registration Office るおいをおきいい参加登録全て必須 Card Type * Card Number * Expiration Date * Card Holder's Name * ●VISA カードの種類を選択カード番号の数字のみを記入 MasterCard Diners Club 1234567890 No spaces or dashes 08 Month 17 Year AMEX JCB 月／年（例：08／17 → 8月2017年） TARO YAMADA 543 Security Code * ている [ Visa / MasterCard / JCB / Diners Club ] 3-digit number printed on the back of your card. It appears after your credit card number (either 16-digit or only the last 4 digit). さ [ AMEX ] 4-digit code printed on the front of your card. It appears after and to the right of your main credit card number. さている back next ー情報セキュリティコードは、クレジットカード裏面に記載されています ba k てていい登録フォーム Registration Form 登録フォーム Please fill in the form in English; - complete all lines hereunder marked with * (mandatory field). - fill in one form per participant. - type the first letter of each word in capital letter. - use ASCII Code only: A to Z, a to z, 0 to 9, and : ! , " , # , $ , % , & , ' , ( , ) , ~ , * , < , > , ? , _ , - , { , } , + , * and ^ System Requirements (recommended) OS: Windows Vista or later version, Mac OS X Browser:Windows: Microsoft Internet Explorer 9 or later version, FireFox3, Chrome Mac OS X: Safari5, FireFox3 Deadline for Early Registration: July 7, 2016 Deadline for Late Registration: October 20, 2016 * All Deadlines are in Japan Standard Time. Certificate of Your Student Status Student Identification Card * にのー Please submit a scanned copy (in either jpeg or pdf format) of your student ID with face photograph on which the expiry date is printed. さたをしてください参照... 学生の方は、学生証の写しが必要です Questionnaire 1) If you are a presenter, please fill in the Abstract Reference No. you received at the time of abstract submission. Please fill in “To be submitted” if you plan to submit an abstract after this registration. を 2)Dietary requirement If you have any dietary restrictions due to health or religious reasons, please fill in below. We will try to meet your request as much as possible. さていただき back さたおる next ba k 【発表者対象】・演題登録済み → 番号（Abstract Reference No）を入力・これから登録　→ To be submitted と入力ください下ててをくださいいいください登録フォーム情報の Registration Form 登録フォーム Confirmation screen for your registration登録情報 Please check all information below and click the [register] button at the bottom. 下 *Your registration has not been completed yet. 登録ており Please be sure to click the [register] button to complete the procedure. さたをし s をしてください。て登録てい Participant Title Prof. * Family Name * Given Name Yamada Taro * Middle Name Affiliation ABC Company * Department Department 1 Manager Position Contact Street City Office * * * Prefecture/State/Province/Region Tokyo ZIP/Postal Code * 123 Country * Japan Phone * 81-3-1111-2222 FAX 81-3-3333-4444 e-mail * @ Your Membership (if any) JSAM JSAM Membershp No. 1234 ー Certificate of Your Student Status . pdf Student Identification Card Questionnaire 1) If you are a presenter, please fill in the Abstract Reference No. you received at the time of abstract submission. To be submitted 2) Dietary requirement vegetarian Amount of Payment • Student : JPY10,000 • Post Conference (Practical Training Session in a small group) on November 7 at Tokyo : JPY20,000 • Gala Dinner on November 5 : JPY10,000 JPY10,000× 1person Amount of Total Payment Payment JPY20,000× 1person : JPY40,000 い Credit Card Payment Information Card Type い情報 * VISA Card Number * ************** Expiration Date * 01Month 2018Year Card Holder's Name * Taro Yamada Security Code * *** back register 情報 ba k s てていい登録フォーム登録 Registration Form登録フォーム参加登録 Thank you for your registration for WFAS Tokyo/Tsukuba 2016. Your registration number is wfas-reg-●●●●●. 登録い。。 A confirmation email will be sent to your registered email address automatically. 登録さたさ。 Please print out the confirmation email and present it at the registration desk to receive the Conference materials and a printed receipt.If you do not receive をして登録おいただきをおください。以 any e-mail message within 24 hours after completing registration, please contact the Registration Office. い登録登録の登録おいください。いーームー登録にておりており登録い