IHS2011 VISA Information Sheet
* Please type or write in BLOCK letters and send this sheet in both Word and PDF format
by e-mail: ihs2011-reg@issjp.com or by fax +81-3-3230-3725.
1. Registration Number:
2. Name: (English, as stated on the passport)
/ /
(Given Name) (Middle Name) (Family Name)
3. Nationality:
4. Title: □Prof. □Dr. □Mr. □Ms. (Check the appropriate boxes.)
5. Gender: □Male □Female (Check the appropriate boxes.) Age:
6. Date of Birth: / / (e.g. 01/Jan/1965)
7. Occupation:
8. Organization:
9. Address: □Office □Home (Check the appropriate boxes.)
Country: Postal Code:
Tel: Fax:
(+Country code - Area code - Phone No.) (+Country code - Area code - Phone No.)
10. Flight schedule:
Arrival Date: / /2011 Flight No.: (e.g. JL321)
(Day / Month / Year)
Departure Date: / /2011 Flight No.: (e.g. JL123)
(Day / Month / Year)
Thank you for your cooperation.
Itinerary
Registration Number:
Full Name:
Date Plan of Activity Phone Where to Stay
e.g.
2011/09/14 Arrive at Narita by JL000 000-000-0000 XXX Hotel
e.g.
2011/09/15 Participate in XXX conference 000-000-0000 XXX Hotel
-17
e.g.
2011/09/18 Depart from Narita by JL000
Please fill in your detailed plan in Japan during your stay from your arrival to departure.