----------------- Cut here and E-mail ------------
To :
Tsutomu Sasao
Dept. of Computer Science and Electronics
Kyushu Institute of Technology, Iizuka 820-8502, Japan
E-mail sasao@cse.kyutech.ac.jp

           Reed-Muller 2009 Registration FORM

 (Please type or print in block letters.)
  Name:
------------------------------------------------------
          (First and Middle)  (Family name)   

 Title: [Prof. Dr. Mr. Ms.])
 
  Affiliation:
----------------------------------------------------
 Mailing Address: [Office,  Home]


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  Country:
  Tel:
  Fax:
  E-mail:
      
 PAYMENT: 
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                    Before April 20    After April 20
  Participant          [ ]  Yen 15,000-      [ ]  Yen 20,000-

  Over page charge  Yen 3000 X [  ] pages 
  Extra paper charge  Yen 15,000 x [  ] papers.
   (For each registration, at most one paper can be presented.
   Thus, a group of three registrations can present up to three papers
   without extra charge ) 
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PAYMENT
  Total:                       Yen.             
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[  ]  For Residents in Japan. I (We) have remitted the above amount  on            (date)
                                              --------------
        under the name of                             (name of remitter)
                        -----------------------------------
        to the account of REED-MULLER.
        A COPY OF BANK REMITTANCE RECEIPT TO BE SENT TO Sasao.
        Payments must be in Japanese yen.
 [  ] For Visitor from oversea: I sent the money by Credit Card.

***********************************************************************
[  ] I have ordinary food.
[  ] I need special food: Specify [                               ]
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Payment of the pre-registration fee must be one of the followings: