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Please
complete below and return to Secretariat, before
September 25th B.E. 2551 (2008) by E-mail.
If
you can not send E-mail, please send this form by Fax.
E-mail : 24wfb@entryweb.jp
Fax :
+81-3-3496-1057
*Your
personal information will be handled based on the Privacy Policy of JBF.
**Your
registration by filling out this form will be considered as you have agreed
with our privacy policy.
(Please
fill out in block letter and check appropriate boxes.)
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... WFB... WFBY ... WBU
Name
of WFB/ WFBY Regional Centre
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Position
Participate
as:
... Delegate ... Observer ...Accompany
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Name (As
shown on passport in alphabet)
Family
Name
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Given
Name
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Middle
Name
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Photograph
(with
your name and passport # on the back)
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*Also
with Chinese Characters if available
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Passport
Number:
Expiration
Date:
D /
M / Y
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Nationality (As
shown on passport)
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Date
of Birth
D /
M / Y
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Gender
...Male ... Female
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Address
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Tel
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Fax
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E-mail
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Meal
Preference: ... Vegetarian ... Non-Vegetarian
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Name
of One Preferred Roommate: Relation
(optional):
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(For
Observer Only) I would
like to stay at: ... (A)
Asakusa View Hotel ... (B)
Hotel Sunroute
JPY
110,000 JPY 90,000
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Bank
Transfer
I
(We) have remitted or will remit the above sum of JPY
(total)____________ on (date)
____________
by
the name of (remitter)__________________ through
(name of bank) __________________________
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Airport
Pick Up (Available Only on Nov. 13th and 17th) ... 13th
Required ... 17th
Required
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Date
of Arrival
2008/Nov/13
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Time
of Arrival
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Flight
Number
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From
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To
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Date
of Departure
2008/Nov/17
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Time
of Departure
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Flight
Number
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To
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From
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Remarks
:
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