IEEE IWCIA2016 Registration Form

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All attendees must register for the workshop. Registration (student and non-student) includes admission to all workshop sessions, a copy of the conference proceedings, lunch service and coffee breaks. Banquet fee is not included in this registration.

Attendee's Information

Registration Type *

Please select the appropriate registration type.

IEEE SMC Member (Hiroshima and Japan Chapter Member only)

IEEE Member

IEEE Student Member

Non-IEEE Member

Registration Title *

Prof.

Dr.

Mr.

Ms.

Registration Name *

Enter your name as yo would like it to appear on your ID badge.

Registration Affiliation (Please include country) *

e.g. Hiroshima City University, Japan

Registration E-mail Address *

Dietary *

No Restriction

Vegetarian

Halal

Other:

Billing Information

Billing Name (First name) *

Fitst Name

Billing Name (Last Name) *

Last Name

Billing Address *

Billing Address (City) *

Billing Address (State / Province)

Billing Address (Zip / Postal code) *

Billing Address (Country) *

Billing Phone *

+Country Code - Area Code Number (+81-82-123-4567)

Billing E-mail Address *

Valid E-mail Address

Paper Information

If you register as an author for your accepted paper, please fill in the following items.

Paper ID

e.g. 601

Title of Paper

Submit

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