日本語でのご案内 - WFAS Tokyo/Tsukuba 2016

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