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APO2019 8th Asian Polyolefin Workshop

Higashi Hiroshima City Arts & Culture Hall Kurara, Higashi-Hiroshima City,
Hiroshima, Japan from December 2-6, 2019.

Registration Form

After filling out the following form, please click "Confirm" for confirmation.
Fields marked with an * are required.

Name and Affiliation
* Title
* Name
First(Given) nameMiddle nameLast name
* Use capitals only for initial letters. (e. g. John Smith)
* Affiliation
* Department
Abbreviation of affiliation
Postal Address and E-mail
* Contact
* Address 1
(Street No., Bldg. Name)
* Address 2
(City/Town)
* Address 3
(State/Province/Prefecture)
* Zip/Postal Code
* Country
* E-mail address
(Retype the address for verification.)
* Phone
+ e.g. 81-11-111-1111
Fax
+ e.g. 81-11-111-2222
Registration
  Early Registration
(Extended to September 30th)

(before September 15th)
Late Registration
(after October 1st)

(after September 16th)
* Registration


Accompany pesron(s) 10,000 JPY/person
person(s)
Accompany pesron(s)'s Name Person1
Person2
Person3
Person4
Person5
Payment
Fee JPY
* Payment Method
If paying by credit card, please fill out the following information. If paying by bank transfer, please note that the detail of our account information will be shown on the auto-response form. Also all the bank charges should be borne by the remitter (you).

Participants from Japan (Domestic) 日本国内の方:
支払は銀行振り込みでお願い致します。
振込先
広島銀行 西条南支店
店番 207 口座番号 普通 3336951
名義 アジアポリオレフィンワークショップ2019 代表 塩野 毅
(*) Credit Card
Card Holder's Name (as it appears on the card)
[Note]
1. Please note that your credit card will be charged by our official credit card service provider, the "Clear Members."

2. The Clear Members will e-mail you the following e-invoice message to request that you complete the payment of the relevant fees by credit card.
Contact: Clear Members
Contact e-mail: apo2019-payment@clear-members.com
Contents: Payment details with check-out URL
Period of e-mail Transmission: Within 5 business days after registration
Payment deadline: As noted in the e-invoice message

3. Please contact us via e-mail if you cannot meet the deadline or if the transaction is unsuccessful.
Contact e-mail: apo2019-payment@clear-members.com
Contact name: TAKITA Tatsuhiko(Mr.)

4. The name "Clear Members" will appear on your credit card statement.

5. Please DO NOT SEND your credit card information with your return message.

6. The default language setting of the webpage you are about to access is Japanese.
You can change the setting by selecting one from the pull-down menu on the upper right corner of the page ( English / 日本語 / 中文 ).