Condition Monitoring and Diagnostic Engineering Management - Excel by wan16609

VIEWS: 45 PAGES: 2

More Info
									                                                   23rd International Congress on
                                   Condition Monitoring and Diagnostic Engineering Management
                                                           COMADEM 2010
                                 June 28-July 2, 2010, Nara Prefectural New Public Hall, Nara, Japan

                                                               VISA APPLICATION FORM

                                 Fill and return this form not later than May 3, 2010 by e-mail.

(1) Personal Data
    Your name and date of birth have to be the same as ones written in your passport.


                                                                                                                                                  [ ] Male
      Name
                          (Surname)                  (Middle    (First Name)     (Chinese Character if you are Chinese)                           [ ] Female
                                                      Name)

     Date of
                                                                                       Age                      Nationality
      birth
                               (Day)                 (Month)       (Year)


     Institution / Affiliation
                                                                                                                          (Chinese Character if possible)


              Address
                                                                                 Zip                                    Country


     Occupation/ Position
                                                                                                                          (Chinese Character if possible)

        Tel                                                                                   Fax

      e-mail                                                                                                                  [ ] e-mail is NOT available



        Home Address
                                                                                 Zip                                    Country

    City Name where you will apply your visa




(2) Flight Schedule (Please inform us of your schedule, even if it is tentative. )
                                                                                                               Date
      Date
                    Flight #             Departure Airport     Time                     Arrival Airport      (D/M/Y)
     (D/M/Y)
                                                                                                             and Time
                                                                                 [ ] Narita     [ ] Kansai
                                                                        >>       [ ] Nagoya [ ] Other
                                                                                 (               )
                                 [ ] Narita       [ ] Kansai
                                 [ ] Nagoya       [ ] Other                 >>
                                 (            )



(3) Hotel you stay (Please inform us of hotel, even if it is tentative. )
      Date
                                     Name of Hotel                                           Address                                        Tel
     (D/M/Y)




(4) Memorandum: Relationship between you and accompanying person




     Please send this form to COMADEM 2010 Secretariat by e-mail.
     tel: +81-749-28-8395 fax: +81-749-28-8496 e-mail: info@comadem2010.jp
国籍           0
職業           0        0
氏名           0        0    0   0
性別   [ ] Male [ ] Female
生年月日         0        0    0
年齢           0

								
To top