======================================================================================= PAYMENT FORM - 9th TAHI IPv6 Interoperability Test Event Payment Due: Apr 27, 2007 ======================================================================================= Fax the information below to: 9th TAHI Registration Desk c/o Maki Ikegami, e-side, inc. Fax: 81-3-3585-8162 ======================================================================================= Participant Name: ___________________________________________________________________________________ Organization Name: ___________________________________________________________________________________ Registration Number: ___________________________________________________________________________________ ======================================================================================= REGISTRATION FEE Please check the box General:  early registration discount 15,000 JPY( - 17:00 JST April. 16, 2007)  regular registration 30,000 JPY( Apr. 16 - 17:00 JST Apr. 27, 2007) Student:  early registration discount 10,000 JPY( - 17:00 JST April. 16, 2007)  regular registration 15,000 JPY( Apr. 16 - 17:00 JST Apr. 27, 2007) ======================================================================================= LUNCH PRICE@ 1,000JPY/lunch box ======================================================================================= ======================================================================================= CREDIT CARD INFO ======================================================================================= Credit Card: [ ] VISA [ ] MasterCard [ ] AMEX Cardholder's Name: ___________________________________________________________________________________ Card Number: ___________________________________________________________________________________ Expiry Date: MM YY ___________________________________________________________________________________ ======================================================================================= PLEASE DO NOT SEND CREDIT CARD INFORMATION BY E-MAIL. YOUR NDA MUST BE SUBMITTED TO COMPLETE REGISTRATION. =======================================================================================