<p>2016 International Workshop on Smart Info-Media Systems in Asia (SISA 2016)</p><p>14-17 September, 2016 Classic Kameo Hotel & Serviced Apartments, Ayutthaya, Thailand Registration Form</p><p>Please complete and send this form by Friday, 12 August via e-mail to: Prof. Hiroyuki Tsuji (Kanagawa Institute of Technology, Japan) [email protected]</p><p>Attendee Information</p><p>Name Last First Middle Prof Dr Mr Ms Affiliation</p><p>Address</p><p>City/State Zip Code Country Phone Fax E-mail Submission ID</p><p>Registration Details Registration Type □ Regular (Member) 20,000 JPY □ Regular (Non-member) 25,000 JPY □ Regular (Non-Japan resident) 15,000 JPY (5,000 THB) □ Student (Member) 10,000 JPY □ Student (Non-member) 15,000 JPY □ Student (Non-Japan resident) 7,500 JPY (2,500 THB)</p><p>Payment Type □ Bank Transfer A transfer will be coordinated by the name of: ______□ Cash</p><p>Free Bus Service Free bus service between Suvarnabhumi Airport (BKK) and Phra Nakhon Si Ayutthaya will be available for all the SISA 2016 participations. Please select a free bus service you would like to use from the following list:</p><p>On the way to the venue:</p><p>□ September 13, 2016 □ Depart from Suvarnabhumi Airport at 7:30 AM □ Depart from Suvarnabhumi Airport at 6:00 PM</p><p>□ September 14, 2016 □ Depart from Suvarnabhumi Airport at 7:30 AM □ Depart from Suvarnabhumi Airport at 6:00 PM</p><p>□ I do not use a free bus service from Suvarnabhumi Airport</p><p>On the way back from the venue:</p><p>□ September 16, 2016 □ Depart From Phra Nakhon Si Ayutthaya at 6:00 PM</p><p>□ September 17, 2016 □ Depart From Phra Nakhon Si Ayutthaya at 5:00 AM □ Depart From Phra Nakhon Si Ayutthaya at 4:00 PM</p><p>□ I do not use a free bus service from Phra Nakhon Si Ayutthaya</p><p>Technical Tour We are going to offer an attractive technical tour on September 17. It’s free except admission fees to temples, museums, and so on. All the SISA participants who would like to join the tour are asked to check the following checkbox:</p><p>□ I would like to join the technical tour on September 17, 2016. SISA 2016 – Privacy Policy</p><p>We (SISA 2016 Organizing Committee) are committed to protecting the personal information of the applicants. Your personal identifiable information (hereinafter “personal information”) will be collected via this form only when you make registration for 2016 International Workshop on Smart Info-Media Systems in Asia (hereinafter “SISA”). Without an applicant’s consent, we will not use such information for the purposes other than operating and managing the SISA, preparing the participants’ list, responding to inquiries from applicants for the SISA, offering the SISA information to the applicants, except for the personal information collected in connection with other websites. In case there is an error in your personal information collected for the SISA, please inform the administrators to have it corrected or deleted. Offering personal information is voluntary, but please note without offering the necessary information, you are unable to attend the SISA.</p><p>Administrators of personal information collected for SISA 2016. Mitsuji Muneyasu General Co-Chair, 2016 International Workshop on Smart Info-Media Systems in Asia</p>