Registration Form
             -- JCNP2004 (March 07-10, 2004) --

Full Name (Family/First/Middle):
[ ]Male/[ ]Female
Title (Prof./Dr./Mr./Ms.):
Affiliation:
Postal Address:

E-mail:
Phone/Fax:

TRAVEL SCHEDULE
  Arrival Date:
  Departure Date:
  * If the travel schedule is not yet fixed, please let us know
    these items later when fixed.

Do you attend the symposium banquet?  [ ]Yes/[ ]No
*The fee of the banquet is 5,000 yen (2,500 yen for students).


  PLEASE SEND THIS FORM BY E-MAIL (jcnp2004@kutl.kyushu-u.ac.jp)
  OR BY POSTAL MAIL TO:

    Kazuyuki Ogata
    Department of physics, Kyushu University,
    6-10-1 Hakozaki, Higashi-ku, Fukuoka 812-8581, Japan