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 20241128
name of symposium 54th Petroleum-Petrochemical Symposium of the Jpn. Petrol. Inst. (Hiroshima)
date 2024-11-28 ~ 2024-11-29
dead line for registration 2024-11-13
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
JPY8,030-		student member
JPY4,070-		corporate member
JPY11,000-		non-student member
JPY5,060-		non-JPI member
JPY14,080-		none
banquet (Nov. 28)
regular
JPY7,040-		student
JPY4,070-		companion
JPY4,070-		none
No.2
Name First name
Family name & middle name
Department
Member ID
registration fee
personal member
JPY8,030-		student member
JPY4,070-		corporate member
JPY11,000-		non-student member
JPY5,060-		non-JPI member
JPY14,080-		none
banquet (Nov. 28)
regular
JPY7,040-		student
JPY4,070-		companion
JPY4,070-		none
No.3
Name First name
Family name & middle name
Department
Member ID
registration fee
personal member
JPY8,030-		student member
JPY4,070-		corporate member
JPY11,000-		non-student member
JPY5,060-		non-JPI member
JPY14,080-		none
banquet (Nov. 28)
regular
JPY7,040-		student
JPY4,070-		companion
JPY4,070-		none
No.4
Name First name
Family name & middle name
Department
Member ID
registration fee
personal member
JPY8,030-		student member
JPY4,070-		corporate member
JPY11,000-		non-student member
JPY5,060-		non-JPI member
JPY14,080-		none
banquet (Nov. 28)
regular
JPY7,040-		student
JPY4,070-		companion
JPY4,070-		none

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