Registration
form	
 The 1st International Forum of Global Transfer of Safety and 
 Health Technologies 
by World Health Risk Management Center (WHRMC) 
   	                          　　　　　     to be held in Tokyo, November 1 - 2, 2005.

(Notice) 
This form is only used for presentation in this forum.  All audiences are requested to use another registration form, which is available in the following office.
　　　　World Health Risk Management Center Office
          	c/o  Kato & Ooka Lab., Institute of Industrial Science, The University of Tokyo.
          	(E-mail) jsrmpm-office@umin.ac.jp  
           	(Fax) +81-3-5452-6432  　      (81 is a country code of Japan) 

 (Please type) Fax till September 30, 2005 after payment.
   　　  
Male □　　　　 　Female □                     
                                                 
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▲Surname                                          ▲ Town
                                                 
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▲First name                                         ▲Country
                                                 
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▲Title                                              ▲ Telephone (country code, are code, number)
                                                 
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▲Organization                                      　▲Fax
                                                 
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▲Mailing address                                     ▲E-mail
                                                 
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▲Postal code                                         ▲Please indicate the name of accompanying persons 

A.  REGISTRATION FEE                                                           	
Please note that the registration is not valid until the payment has been received.

URMPM MEMBER for presentation	US$/PERSON	No. of participants	US$/total     	
 By September 30, 2005	200 $ 			
Non URMPM MEMBER for presentation	US$/person	No. of participants	US$/total    	
 By September 30, 2005.	300 $			
Total 	
1) The fee of the reception and banquet on November 1, 2005 is 50 USD. 
   Those don’t cover your hotel accommodation.
2) Any presentation with payment after September 30, 2005 is cancelled, so that such presentation will not be included in the final program.
.   　
B.  ACCOMODATION	
The Conference place locates on Shibuya area in Tokyo.  
For discount hotels, consult http://www.e-hoteljapan.com/.
The above tourist are also available for hotel accommodation on their English homepages. 

C. PAYMENT WAYS	

Please pay before September 30, 2005.

(A)	CREDIT CARD

 Visa or Mastercard are acceptable. Send the following information with this registration form by fax.
1) Card number:   
2) Your name on the card:
3) Valid date:
4) Amount of payment:  

Don’t send your signature and the secret number of the card!

(B)	BANK TRANSFER

Bank: UFJ Bank, Kamishakujii Branch, Japan. 
Account: URMPM  Number 3990328.

(Note) URL of international branches of UFJ Bank is seen as follows. 
http://www.ufjbank.co.jp/ippan/english/overseas/index.html

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Please fill all in this Registration Form, and fax them to Registration Office shown in the below.  All charged participants should also fax copies of APPLICATION FOR REMITTANCE and STATEMENT OF REMITTANCE of your bank transfer.  After this registration, the Abstract Submission Form should be e-mailed to the corresponding Registration Office by September 30, 2005.  The e-mail address appears in the Abstract Submission Form.

Please return this FORM, APPLICATION FOR REMITTANCE and STATEMENT OF REMITTANCE by fax to 

 WHRMC Registration Office:  Ms. Kazue Moriyama
c/o Kato & Ooka Lab., Institute of Industrial Science, The University of Tokyo.
         (Fax) +81-3-5452-6432  1 is a country code of Japan)