In order for you to prepare official documents to apply for entry visa into Japan, please fill in and send back the form to the Secretariat. (Please type or print CLEARLY in BLOCK LETTERS) in due course.

Paper No. Registration No.

1. Personal Data (□Mr. □Ms.)

Name / *Please print your name as shown in your passport
*If you are Chinese, please print your name in Chinese character.
Family / First / Middle
Nationality / Date of Birth (mm/dd/yyyy) / / /
Organization/Department
Job Title
Postal Address
*P.O.Box not accepted
Home Phone Number
(Incl. country code) / + / Passport Number
E-mail

2. Personal Data of Accompanying Person if Any (□Mr. □Ms.) *If more than 2, print the same details in [4. Memo].

Name / *Please print your name as shown in your passport
*If you are Chinese, please print your name in Chinese character.
Family / First / Middle
Nationality / Date of Birth (mm/dd/yyyy) / / /
Organization/Department
Job Title
Posting Address
*P.O.Box not accepted
Home Phone Number
(Incl. country code) / + / Passport Number
E-mail


3. Itinerary in Japan *If your itinerary has yet to be decided, please let us know your planned schedule.

*If you have any other plans besides SPAWC2017, please specify the details in [4. Memo].

Arrival (to Japan)
Departure date
(from your country) / Departure airport
(in your country) / Flight No.
Arrival date
(in Japan) / Arrival Airport
(in Japan)
Departure (to your country)
Departure date
(from Japan) / Departure airport
(in Japan) / Flight No.
Arrival date
(in your country) / Arrival airport
(in your country)
At which hotel will you be staying?
Address of hotel

4. Memo IMPORTANT if you have any other plans besides attending the congress, please specify, including dates.

I, the undersigned attending SPAWC2017 to be held in Sapporo, Japan, hereby certify that the statements made

by me in this form are true and correct to the best of my knowledge.

I agree:

A)  To obey Japanese law during my stay in Japan.

B)  To report to the Secretariat of SPAWC2017, if requested any.

C) To report any schedule change about my stay to the Secretariat of SPAWC2017, and to follow the instructions.

D) Not to engage in any unrelated activities other than attending the congress.

E) To return to my home country immediately after SPAWC2017.

F) To declare that I am healthy and free of any contagious disease.

G)  To be responsible for all necessary expenses regarding, but not limited to, my travel and accommodation.

Date: Name:

Please read the followings, and your signature is required. We would like to emphasize that it is absolutely necessary for us to prepare necessary documents unless you complete all sections in the form with your signature.

We look forward to receiving the information at your earliest convenience.

Visa Document Support Office of SPAWC2017

c/o EC PRO Inc.

5F, Kitaguchi-Yoshiya Bldg., kita 7, Nishi 4, Kita-ku

Sapporo JAPAN 060-0807

E-mail:

Fax: +81-11-299-5911

2