******************************************************* * Fast Software Encryption 2001 Registration Form * ******************************************************* April 2-4 2000, Royal Park Hotel Nikko, Yokohama, Japan To be returned to: Yasuyuki Sakai Information Technology R&D Center Mitsubishi Electric Corporation 5-1-1 Ofuna, Kamakura, Kanagawa, 247-8501, JAPAN FAX: +81-467-41-2185 / E-mail: ysakai@iss.isl.melco.co.jp [ ] Last name : [ ] First name : [ ] Affiliation: [ ] Address : : : [ ] Country : [ ] Telephone : [ ] Fax : [ ] E-mail : The information above will be published in a list of participants at the workshop. If you do not like an item or items to appear in the list, please indicate it in the brackets (e.g. [X] ). Name of accompanying person(s): [FSE2001 Registration] Registration Fee (before Feb 28) 35000 Yen ........ Yen Registration Fee (after Mar 1) 40000 Yen ........ Yen Additional Dinner for Guest 8000 Yen x .. person(s) = ........ Yen Total ........ Yen If you have special requirements with respect to dietary or any other matters, please indicate it. Arrangement can be made. Cancellation policy of the registration: The registration fee will be returned in full before March 10, 2001. No refund will be made in respect of cancellation after this date. [FSE2001 Accommodation] To reserve a room in Royal Park Hotel Nikko at a special rate for FSE2001, please fill in the following. This rate is only applied to participants registered with this registration form. The rate includes breakfast, tax and services. A Single Room 17000 Yen x .. night(s) = ........ Yen A Twin Room (with two breakfasts) 28000 Yen x .. night(s) = ........ Yen Total ........ Yen Check in date : Check out date: Cancellation policy of the accommodation: The room charge will be returned in full if cancelled no later than two days before the check-in date. 80% of the room charge will be returned if cancelled one day before the check-in date. [FSE2001 Payment] By Credit Card: Fill in the following credit card information. Credit card (select one): Visa Card Master Card Last name : First name : Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Expiration date (MM YY): __ __ __ __ I hereby authorize NISHITETSU TRAVEL to charge my credit card. Payment: ........ Yen (registration fee + accommodation fee) Date : Card Holder's Signature: By Bank Transfer: A copy of the transfer receipt must be sent with the registration form. FUJI BANK, Ofuna Branch (299) Account Number: 1986751 Account Name: FSE2001 (an ordinary account) Address: 1-8-7 Ofuna, Kamakura, Kanagawa 247-0056 Japan TEL: +81-467-44-2161 / FAX: +81-467-47-0902 [Messages to FSE2001 Secretariat (if any)]