Pre-Registration

Please press “Confirm” after filling out required field.
Mandatory field
Please make sure to provide the accurate e-mail address to receive the confirmation and the future correspondence.

※You can resister on-site at the reception desk if the seats are still available.

■ Participant information registration

Name First Name Family Name
Category Doctor: Pre-Registration 25,000JPY
Co-Medical: Pre-Registration 5,000JPY
Resident: Pre-Registration 2,000JPY
Student: Free Registration
Name of Affiliation
Department
※If not applicable, please fill in "N/A".
Zip code
(half-width digit)

Please input without hyphenation(-)
Address
Phone
(half-width digit)

Please input without hyphenation(-)
Fax number
(half-width digit)

Please input without hyphenation(-)
Email
(half-width alphanumeric and digit)
Email again
(half-width alphanumeric and digit)

The same e-mail address for confirmation