Offline Registration form   (Onsite)	
 　　   9th World Congress of Clinical Safety
By International Association of Risk Management in Medicine  
                    (IARMM)
   	  1st (Wed) – 14th (Thu) September 2021
On-demand in Internet

Registration deadline:
(Presenter whose abstract is accepted)   31 July 2021
(Audience)                             5 September 2021
         
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▲ First name                                        ▲ Middle name    
      
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▲ Last name                                        ▲ Telephone number
                                                 
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▲ Title                                          　 ▲ Fax number
                                                 
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▲ Institution                                      　▲ Email address

▲	Postal address　   

A. Registration fee                                                     	

	Price	Price	
	IARMM 
non-member	IRMPM member, or Undergraduate student	
Delegate Fee for 14 days (The price is tax free.)	(   ) € 150	(   ) € 100	

The delegate fee covers all printed materials (proceedings, journals, etc) 

B. registration payment ways	
　　  　　　　　　
In a case of credit card payment, please use our online payment system (PayPal Ltd) in the Congress homepage.
http://www.iarmm.org/5WCCS/
  .           
In a case of bank transfer, send the following bank account.
Bank name: Bank of Tokyo-Mitsubishi UFJ
Branch name: Hongo Branch
Branch number: 351
Account name: IARMM
Account number: 0111719
Sift code: BOTKJPJT

(Note)  For check use, you have to get an international check (Demand Draft) in your bank.  Thus, instead of check payment, you should use the following bank transfer. We don’t accept any check. 

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In a case of bank transfer payment, please fax this form to the following office till the registration deadline.
And, fax a copy of your receipt, too.

9th World Congress of Clinical Safety 2019 in Prague
Administration Office
　International Association of Risk Management in Medicine (IARMM)
(Tel / Fax) 　+81-3--3817-6770 
(Email)  9wccs@iarmm.org 
4-7-12-102 Hongo, Bunkyoku, Tokyo,113-0033, JPN