The Japan Petroleum Institute - symposium registration form -

Items with * are to be filled.
You can register maximum 4 participants at one time.
  symposium information
symposium ID 20190528
name of symposium The 62th Annual Meeting of JPI
date 2019-05-28 ~ 2019-05-29
dead line for registration 2019-05-14
payment method* Registered mail   Transfer by bank  
payment will be at (year / month / day):
/ /
Credit card  
annotation *Available credit card: VISA, Maser, JCB, Amex
participant ID sending address
representative name* First name

Family name & middle name
organization
affiliation
address category organization home
address*
phone number*
E-mail address*
bill acquired
receipt acquired
comment

  participants
No.1
Name First name
Family name & middle name
Department
Member ID
Registration fee
JPI personal member
JPY6,000-
JPI student member
JPY3,000-
JPI corporate member
JPY8,000-
non-student
JPY4,000-
non-member
JPY11,000-
none
banquet
personal member
JPY7,000-
student / companion
JPY4,000-
none
No.2
Name First name
Family name & middle name
Department
Member ID
Registration fee
JPI personal member
JPY6,000-
JPI student member
JPY3,000-
JPI corporate member
JPY8,000-
non-student
JPY4,000-
non-member
JPY11,000-
none
banquet
personal member
JPY7,000-
student / companion
JPY4,000-
none
No.3
Name First name
Family name & middle name
Department
Member ID
Registration fee
JPI personal member
JPY6,000-
JPI student member
JPY3,000-
JPI corporate member
JPY8,000-
non-student
JPY4,000-
non-member
JPY11,000-
none
banquet
personal member
JPY7,000-
student / companion
JPY4,000-
none
No.4
Name First name
Family name & middle name
Department
Member ID
Registration fee
JPI personal member
JPY6,000-
JPI student member
JPY3,000-
JPI corporate member
JPY8,000-
non-student
JPY4,000-
non-member
JPY11,000-
none
banquet
personal member
JPY7,000-
student / companion
JPY4,000-
none

Your personal information for the registration is used only for the management of this event.