[MRM2021] Sponsor Application Form

Company Name

Company's Address

Contact Person

Family Name

Middle Name

First Name

Department / Division

E-mail

Tel

Please check the sponsor items which you apply.

CONFERENCE SPONSOR:

PLATINA SPONSOR

PLATINA Sponsor (Fee: 1,000,000JPY)

GOLD SPONSOR

GOLD Sponsor (Fee: 600,000JPY)

SILVER SPONSOR

SILVER Sponsor (Fee: 300,000JPY)

SYMPOSIUM SPONSOR

Symposium Sponsor (Fee: 50,000JPY /per unit)

【Symposium Sponsor】

How many unit do you want to apply ?

Symposium or person who intoroduce this sponsorship:
Please fill in the name and symposium number, if you have person or symposium that introduce this MRM2021 Sponsor.

Sumposium number, if any

(Ex. A-1)

Person's Information, if any

Family Name

Middle Name

First Name

Affiliation

Advertisement:

Would you like to apply for Luncheon Seminar ?

Yes

No

[Advertisement] desired page

Outside back cover: four colors / one page (Fee:150,000JPY)

Inside front cover: four colors / one page (Fee:120,000JPY)

Inside back cover: four colors / one page (Fee:100,000JPY)

Front matter:Monochromatic / one page (Fee:80,000JPY)

Back matter: Monochromatic / one page (Fee:60,000JPY)

If yes, please check the box of desired page.

Symposium or person who intoroduce this sponsorship:
Please fill in the name and symposium number, if you have person or symposium that introduce this MRM2020 Sponsor.

Sumposium number, if any

(Ex. A-1)

Person's Information, if any

Family Name

Middle Name

First Name

Luncheon Seminar:

Would you like to apply for Luncheon Seminar ?

Yes

No

[Luncheon Seminar] date

December 13, 2021 ( Fee:200,000JPY)

December 14, 2021 ( Fee:200,000JPY)

December 15, 2021 ( Fee:200,000JPY)

December 16, 2021 ( Fee:200,000JPY)

December 17, 2021 ( Fee:200,000JPY)

If yes, please check the box of desired date.

Symposium or person who intoroduce this sponsorship:
Please fill in the name and symposium number, if you have person or symposium that introduce this MRM2021 Sponsor.

Sumposium number, if any

(Ex. A-1)

Person's Information, if any

Family Name

Middle Name

First Name

Confirmation Page
(Click the center button to go to the confirmation page)