========================================================================== REGISTRATION FORM FAX: +81-3-3502-3169 ========================================================================== PFLDnet2006 Fourth International Workshop on Protocols for Fast Long-Distance Networks February 2nd (Thu.) and 3rd (Fri.), 2006 Nara Prefectural New Public Hall, Nara, Japan ========================================================================== * - complete one form per participant * - DO NOT email credit card information * - return by FAX to: +81-3-3502-3169 PFLDnet2006 Registration Desk ATTN: MR. SASAMURA c/o JTB Tokyo Shinbashi Office Tel: +81-3-3504-2591 (weekdays 9:30-17:30 JST) Fax: +81-3-3502-3169 email: pfldnet2006-office@e-side.co.jp ========================================================================== 1. PARTICIPANT INFORMATION [Registration Policy] - workshop registration is limited to 60 attendees - please use the email address of your organization when registering - registration may be rejected if the attendee's organization cannot be confirmed ========================================================================== First Name: ---------------------------------------------------------- Family Name: ----------------------------------------------------------- Organization: ----------------------------------------------------------- Country: ----------------------------------------------------------- Tel: Fax: ----------------------------------------------------------- email: ----------------------------------------------------------- special dietary needs: ----------------------------------------------------------- ========================================================================== 2. REGISTRATION ========================================================================== [ ] Standard 40,000 JPY [ ] Student 20,000 JPY ========================================================================== 3. ACCOMMODATION (rates below include service charges and taxes) ========================================================================== [ ] Hotel Nikko Nara (single rooms with LAN access are now fully booked) [ ] Single 8,500 JPY/night [ ] Twin (single use) 10,500 JPY/night [ ] Double (single use) 10,500 JPY/night [ ] Nara Hotel (dial up Internet access only) [ ] Single 10,000 JPY/night (limited availability) [ ] Twin (single use) 20,000 JPY/night Feb. ____ IN / Feb. _____ OUT , ______ NIGHTS ========================================================================== 4. CARD INFORMATION ========================================================================== ** the card below will be charged in the amount of the registration ** fee indicated above plus a 5,000 JPY hotel deposit (as applicable). [ ] VISA [ ] MasterCard [ ] AMEX Cardholder's Name: ----------------------------------------------------------- Card Number: ----------------------------------------------------------- Expiry Date: MM YY ----------------------------------------------------------- ==========================================================================