The 3rd Hiroshima Workshop
-- Novel Functional Materials with Multinary Freedoms --
November 16-19, 2005
Higashi-Hiroshima Campus, Hiroshima University

Please complete the registration form and send to 
iscoe@hiroshima-u.ac.jp
with subject: registration

Registration and Accommodation Deadline:  October 1, 2005. 

We will return an acknowledge mail to you soon 
after the receipt of the form. 

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The 3rd Hiroshima Workshop
REGISTRATION FORM

   Full Name
     Family: 
     First: 
     Middle initials: 

   Type of participant, please check by x
      (  )  Regular participant
      (  )  Student participant

   Affiliation: 

   Mailing Address
      Street: 
      City: 
      Zip or postal code: 
      Country: 
      Phone: 
      Fax: 
      E-mail: 

   NAME of Accompanying Person(s), if any
      Family: 
      First: 
      Middle initials: 

   Hotel Reservation
      Type of room, please check by x
         (  )  Single room
         (  )  Twin room shared with: 
      Number of Nights: 
      Arrival Date and Time: 
      Departure Date: