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PAYMENT FORM - 8th TAHI IPv6 Interoperability Test Event     Payment Due: Dec 31, 2005 
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Fax the information below to:
	TAHI Registration
	c/o Maki Ikegami, e-side, inc.
	Fax: 81-3-3585-8162

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Participant Name:
___________________________________________________________________________________

Organization Name:
___________________________________________________________________________________

Registration Number:
___________________________________________________________________________________


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REGISTRATION FEE 
General: 30,000 JPY / 15,000 JPY(early registration discount - 24:00 JST DEC. 16, 2005)
Student: 15,000 JPY / 10,000 JPY(early registration discount - 24:00 JST DEC. 16, 2005)
(LUNCH PRICE@   :  1,000JPY/lunch box)
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CREDIT CARD INFO
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Credit Card:	[  ] VISA	[  ] MasterCard		[  ] AMEX

Cardholder's Name:
___________________________________________________________________________________

Card Number:
___________________________________________________________________________________

Expiry Date:		MM		YY
___________________________________________________________________________________


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PLEASE DO NOT SEND CREDIT CARD INFORMATION BY E-MAIL.
YOUR NDA MUST BE SUBMITTED TO COMPLETE REGISTRATION.
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