Organizing Committee (China Office)

The 3rd World Emerging Industries Summit (2015)

Title (Ms/Mr./Dr./Prof. ,etc) Gender Full name-as written in the passport First Middle Last Name in Chinese(if any)

Passport Number Date of Birth Nationality Religious belief （month/date/year）

Company/Organization English Name Chinese (If any)

Position

Industry Category of your organization (Tick “Y”)

[ ] Fortune 500 company [ ] Forbes 2000 company Mailing address [ ] Listed company (quoted / public) except for the above [ ] Government or Parliament [ ] Academia Others: (in details)

Tel Fax country code area code number country code area code number Contact person Mobile & Tel number Emai Website l Description of Your Business Cooperation Information (the more detailed, the better.)

Speech Application (Free) [ ] Yes [ ] No If yes, please submit the speech topic for approval: The organizing committee will inform you of whether your application is approved after your submission. Time and duration of speeches of successful applicants will be scheduled accordingly. Please tick “Y” accordingly if you need free pick-up/see-off service from/to Zhengzhou Xinzheng International Airport. Transport from airport: April 20th and 21st, 2015/Transport to airport: April 23rd, 2015 [ ] Yes [ ] No 1. Please send the completed Registration Form with personal photo (more than 300 pixels in JPEG) by email to us for registration. The formal Confirmation Letter for your participation with registration number will be sent to you soon after the confirmation from the organizing committee. 2. Please provide us with your flight information before April 6, 2015 for our free hotel room arrangement and all the other reception services for you.

Organizing Committee (China Office): Contact Person: Ms. Fiona Qi Tel: + 86 10 64987220 Fax: + 86 10 64963611 Email: [email protected] Website: http://weis.apceo.com