PSSJ2021 Registration

Create a New Account

Please fill in your Personal Information below; (*required fields)

Personal Information

Name/氏名*

Family name/姓:	例）山田 e.g.)Smith	Middle name:	e.g.)A.	First name/名:	例）花子 e.g.)John

Title/職位*

Affiliation / Institution*

例）富山大学
e.g.)University of Toyama
*Please input your university/company name ONLY.
Department name is NOT required

Mailing Address to receive a receipt /住所情報（領収証送付先）
国内在住の方は日本語で入力願います。
Address (住所）* If you want to receive a receipt at your office, specify its address including a name of affiliation/institution and department. If you want to receive it at your home, specify your home address. 自宅住所を入力ください。所属宛希望の際は所属期間名、所属課等を含めて入力してください。	例）富山市杉谷2630 富山大学学術研究部薬学・和漢系 e.g.)2630 Sugitani, Toyama City School of Pharmacy and Pharmaceutical Sciences, University of Toyama
State/Province（都道府県）*	e.g.)Cambridge 例）東京都
Poatl code（郵便番号）*	e.g.)CB2 1TN 例）183-8538
County （国名）*	e.g.)United Kingdom 例）日本
Telephone number （電話番号）*	e.g.)+44 1223 4567 例）03-1234-1122
Fax number （ファックス番号）	e.g.)+44 1223 4556 例）03-1234-1112

ID(E-mail address), Password
ID(E-mail address)*	* Enter your E-mail address as your ID. * Enter your E-mail address again for confirmation.
Password*	* Enter password using alphabets and numbers (between 4 and 10 characters). * Enter password again for confirmation.