PIM 2021 Registration Form

※ indicates a required field

Name ※
Affiliation ※	Ex. PROS，Ehime University
Job Title ※	Research position (enterprise，university) Enterprise (excluding research position) Student (high school，university，grad school) Public participant Other
Address (prefecture only) ※	prefecture Country home office In 2021、due to infectious disease control measures、only participants from Japan will be accepted.
Phone	Ex. 000-000-0000 home office
FAX	Ex. 000-000-0000 home office
E-mail ※	[Attention!] Please provide an email address where you can receive attachments (PDF). Ex. aaa@bbb.jp
International Symposium ※	Wednesday，September 8 Will attend Online Meeting Only