Online Registration

Your Information

Position Title(*)
(Prof. Staff. Student. etc)

First Name(*)

Initial of
Middle Name

Last Name(*)

Affiliation(*)
(If you are IMR member, please fill in your lab.)

E-mail(*)

@

Visit Schedule and Objective(*)

Prefecture(*)

Your place of work or residence

Affiliation(*)

IMR  Tohoku University  Miyagi Prefecture  Other prefecture  

Purpose(*)

Conference / Meeting  Collaborative Research  Delivery  Visiting Tour/ Other  

Destination(*)

Fill in your visiting lab/section

Corresponding person(*)

Fill in the full name of the host in IMR

I have a permission from my institute for this visit. Insurance of my organization covers my works in this visit(*)

Yes  No  

I have checked my health and there is no flu-like symptom. I will follow IMR measures and protect myself and others from infection.(*)

Yes  No  

I have recorded my daily actions, visiting places, major contacting persons in last two weeks. I haven't visited oversea or risky area in last two weeks and haven't performed risky action.(*)

Yes  No  

Password(*)

Set a password of 12 to 20 characters that is a combination of "half-width alphabetic characters" and "numbers".

Presentation(Please select the "No" below.)

Presentation(*)

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