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 20191031
name of symposium 49th Petroleum-Petrochemical Symposium of the Jpn. Petrol. Inst. (Yamagata)
date 2019-10-31 ~ 2019-11-01
dead line for registration 2019-10-17
payment method* Registered mail   Transfer by bank  
payment will be at (year / month / day):
/ /
Credit card  
annotation *Available credit card: VISA, Master, 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
personal member
JPY9,000-
student member
JPY5,000-
corporate member
JPY12,000-
non-student member
JPY6,000-
non-JPI member
JPY15,000-
none
banquet (Oct. 31)
regular
JPY7,000-
student / companion
JPY4,000-
none
No.2
Name First name
Family name & middle name
Department
Member ID
registration fee
personal member
JPY9,000-
student member
JPY5,000-
corporate member
JPY12,000-
non-student member
JPY6,000-
non-JPI member
JPY15,000-
none
banquet (Oct. 31)
regular
JPY7,000-
student / companion
JPY4,000-
none
No.3
Name First name
Family name & middle name
Department
Member ID
registration fee
personal member
JPY9,000-
student member
JPY5,000-
corporate member
JPY12,000-
non-student member
JPY6,000-
non-JPI member
JPY15,000-
none
banquet (Oct. 31)
regular
JPY7,000-
student / companion
JPY4,000-
none
No.4
Name First name
Family name & middle name
Department
Member ID
registration fee
personal member
JPY9,000-
student member
JPY5,000-
corporate member
JPY12,000-
non-student member
JPY6,000-
non-JPI member
JPY15,000-
none
banquet (Oct. 31)
regular
JPY7,000-
student / companion
JPY4,000-
none

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