IEEE IWCIA2017 Registration Form
All attendees must register for the workshop. Registration (student and non-student) includes admission to all workshop sessions, a copy of the workshop proceedings, and coffee breaks. Banquet fee is not included in this registration.
Attendee's Information
Registration Type
Please select the appropriate registration type.
Registration Title
Registration Name
Enter your name as you would like it to appear on your ID badge.
Your answer
Registration Affiliation (Please include country)
e.g. Hiroshima City University, Japan
Your answer
Registration E-mail Address
Your answer
Dietary
Billing Information
Billing Name (First Name)
Your answer
Billing Name (Last Name)
Your answer
Billing Address
Your answer
Billing Address (City)
Your answer
Billing Address (State / Province)
Your answer
Billing Address (Zip / Postal code)
Your answer
Billing Address (Country)
Your answer
Billing Phone
+Country Code - Area Code Number (+81-82-123-4567)
Your answer
E-mail Address
Valid E-mail Address
Your answer
Paper Information
If you register as an author for your accepted paper, please fill in the following items.
Paper ID
e.g. 701
Your answer
Title of Paper
Your answer
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