The International Workshop on 
Digitization and E-Inclusion in Mathematics and Science 2012 (DEIMS12)
Registration Form

Please fill out this application blank for items 1 - 4 and send it to
   Deims12-office@gaea.jcn.nihon-u.ac.jp
by Jan. 16, 2012 (JST).


1. Basic Information:

   Name:

   Affiliation:

   Mailing Address:

   Phone:
   Fax:
   E-mail:

   Your Stay in Tokyo: Feb.   -   , 2012

   Special Notes to the DEIMS12 Office:



2. Accommodation:

To foreign participants only, we will arrange a hotel room.  For them who stay our specified hotel, we provide an accommodation subsidy (about a half of hotel charges).  If you hope it, please fill out an application form and send it to the contact e-mail address:
    Deims12-office@gaea.jcn.nihon-u.ac.jp
by Jan. 9, 2012.

The specified hotel for foreign participants is:
   Tokyo Garden Palace
   Yushima 1-7-5, Bunkyo-Ku,
   Tokyo 113-0034, Japan
   Phone +81-3-3813-6211
   http://www.hotelgp-tokyo.com/english/map01_e.html


3. Welcome Dinner on Feb. 9, 2012:

We will have a social gathering for dinner on Feb. 9 evening.  Participation will cost about 5,000 Yen.  Please choose one of the following and let us know with this form.
   I want to participate.  Number of participants:
   I don't want to participate


4. Excursion on Feb. 10, afternoon:

We are planning a half-day tour around Tokyo for visiting a historical architecture Senso-JI (Asakusa Kannon Temple) and the Edo Tokyo Museum.  We believe you will be able to enjoy a wonderful time in Japanese winter.

Participation in the excursion will cost around 8,000 yen including a dinner.  Please choose one of the following and let us know with this form.
   I want to participate.  Number of participants:
   I don't want to participate


Thank you very much for your registration.


DEIMS12 Office
  The workshop contact address: deims12-office@gaea.jcn.nihon-u.ac.jp
    Website: http://www.gaea.jcn.nihon-u.ac.jp/deims12/