WELL RetreatɪˮˁǾƔɁɁɺ
Registration Form (Submit by Friday, February 1, 2007¼ɪ21ߓŴȰѓ)
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Name (Romajiɂɺ) |
Name(KatakanaǴǴ) |
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Tel: |
Fax: |
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E-mail: |
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Address() |
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Accommodation: (Put X in the box. We will do our best but, regrettably, we cannot guarantee your choice.)
ʄɮ±ȰԺԺ½ʨѓŴրŶѓǓŁż½ŴʾܓŴˮɮ±
ɇœ˶ŴʅŁݥǓѓǓũܓԺ
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Single bed room (In case no single room is available, share with ) 1ɮ±ԺŁݥ½ƧԺ Ժ |
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Twin bed room 唆ɮ± |
With (name)Ƨ |
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Leave arrangement to organizers ɮ±⾓֓ŴĔ |
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Special Needs:ʄŴŶŴ½ǓݥؓˮրԺ
Conference Fees: *Please note: for a single room,500 per night is added.
˾Ժ*1ɮ±ݥؔŴŧ500ܓ
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The full conference fee (accommodation & workshop) ֮Ժɪʄ֮ؓɺؓDžߓɓԺ |
6,000 yen/* |
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Friday overnight, Saturday workshops only ʄŮƓؓɺؓDžߓɓƓ |
4,000 yen/* |
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Saturday overnight, and workshops (Saturday and/or Sunday) ʄɪƓؓɺؓDžߓɓƓ |
4,000yen/* |
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Workshops only (Saturday and/or Sunday) ؓɺؓDžߓɓƓԺɪؓũŰԺ |
2,000yen/ student1,000 yen |
WELL Annual Membership Fee WELL¼˾ (Member or New Membership찓ɪ찓ũŰ):
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Supporter ˄䩔 |
5,000 yen/ |
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Regular |
2,000 yen/ |
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Student (undergraduate or graduate ɪ§) |
1,000 yen/ |
Paid on 溓 TOTAL ˮ yen /
Mealsȣ: To assist the cafeteria to prepare adequately and meet your needs, please check the meals you expect to eat at the center. Those who will arrive at the center after 10 pm, indicate your estimated arrival time.
ˮȣǓߓƓȣ픆ؓ½ʨѓŴ烓ŧŶѓȣǓؓǴߓܓɁǢºߓǓ22ǔŴēؔœݓѓѓѓ
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FridayԺԺ |
( )Dinner§ȣ |
Arrival time:Ժ Ժ |
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SaturdayԺԺ |
( )Breakfastȣ |
( )Lunchȣ |
( )Dinner§ȣ |
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SundayԺԺ |
( )Breakfastȣ |
( )Lunchȣ |
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Send Transfer or Money to Postal Account: ɵߓŴ溓 WELL 15400-20134041
Please Email this form after your payment to Michele Steele :Email: psisnowar@ybb.ne.jp
˾րʽŶDžߓɺɴɪǼܓɺɴŴEɰɺɴŔŶ
Enquiry for Room registrationɮ±ƔѓŴ˄: ƏHiroko FUJIIE Ժmail:fujiiehiroko@ybb.ne.jp
Enquiry for Retreat/retreat registrationԺMichele Steele (1-4-2 Higashi Hisakata Kiryu-shi Gunma 376-0053)
ɁɁ-ѓ従Ŵ˄ԺDžߓɺɴɪǼܓɺɴ/ ƏԺTEL/Fax 0475-44-1470ԺߓȰѓ