3APFA 2009 Group Registration Form (Minimum 10 Persons)

3APFA 2009 Group Registration Form (minimum 10 persons)

Please clearly complete this form and return it to: Ms Dan-Qing Ren or Ms Hui Zhang Editorial Office, Asian Journal of Andrology Room 302, Building 16, 294 Tai-yuan Rd, Shanghai 200031, China Phone: +86-21-5492 2824 Fax: +86-21-5492 2825 E-mail: [email protected]; [email protected]; [email protected] Forum Website: http://www.asiaandro.com/3APFA

A: Group Contact Information (Fields marked with an * are required)

□ Mr. □ Ms* First (Given) Name* Last (Family) Name* Company/Affiliation/Organization* Mailing/Billing address* Zip Code* City* Country* Tel*

B: Registration Fee

Category Early Registration Late Registration On-site [ By May 31, 2009 ] [ June 1-Sep 30, 2009 ] Registration

Group* (10 or more) RMB3600 RMB3900 RMB4200

All above registration fee depends on the fluctuation of RMB (renminbi) currency. Please consider RMB as the best payment currency. If you would like to pay in USD, the exchange rate will be measured at the same day when you paid by bank or by bank draft. For example, RMB 4500 is equal to USD 658.376 (if the exchange rate is 6.835).

*Students and accompanying persons can not be included in Group registration. If Group registrants would like to submit abstracts, please submit via 3APFA online submission system.

3APFA Secretariat Ms Dan-Qing Ren or Ms Hui Zhang, Editorial Office, Asian Journal of Andrology, 294 Tai-yuan Rd, Shanghai 200031, China Phone: +86-21-5492 2824 Fax: +86-21-5492 2825 E-mail: [email protected]; [email protected]; [email protected] Forum Website: http://www.asiaandro.com/3APFA Registration fees for the group members include: Admission to the opening ceremony, welcome reception, all scientific sessions, exhibit & break areas, daily lunchboxes, delegate kit and meeting materials.

C: Group Members Please have each member in your group fill in the following information form, and then send back all completed forms to us. Please make sure to fill in the information of individual participant.

Salutation*: Prof.____ Dr ____ Mr. ____ Mrs. ______Ms. ______Gender: ______Name*: First Name______Middle Name______Last Name______Nationality or Region*: ______Passport No.*: ______Affiliation/Company/Organization*: ______Mailing Address*: ______City*: ______Post Code: ______Country*: ______Tel*: ______Fax*: ______E-mail*: ______The number of your submitted abstract: ______*required filed

Please summary the Group members information:

Group Name The number of members Total amount of Payment method registration fee Bank Transfer □ Bank Draft □

D: Payment

 Full payment before the given date is recommended.  The Conference Registration must be submitted with the Payment of a bank draft, or bank transfer, otherwise the registration will not processed.  Receipts will be provided at the on-site registration desk.

Payment in US currency will be accepted by the following methods: Bank Transfer Bank transfer from your bank may be made directly to the account below. All incurred fees charged by the processing banks prior to the arrival of the transferred fund should be borne by registers themselves. Please make sure to indicate the name of the Conference “3APFA”, and the Group’s full name or group contact person’s name on the bank transfer, scan or fax to the Forum Secretariat a copy of the receipt of the bank transfer and keep a copy for your own record.

3APFA Secretariat Ms Dan-Qing Ren or Ms Hui Zhang, Editorial Office, Asian Journal of Andrology, 294 Tai-yuan Rd, Shanghai 200031, China Phone: +86-21-5492 2824 Fax: +86-21-5492 2825 E-mail: [email protected]; [email protected]; [email protected] Forum Website: http://www.asiaandro.com/3APFA U.S. Intermediary Bank Wachovia Bank, N.A. New York International Branch

SWIFT PNBPUS3NNYC

Beneficiary’s Bank in China Agricultural Bank of China, Shanghai Branch, Xuhui Sub-Branch

SWIFT ABOCCNBJ090

Beneficiary’s A/C 033924-00801088453

Shanghai Institute of Materia Medica, Chinese Academy of Beneficiary’s Name Sciences

Beneficiary’s Address 294 Taiyuan Rd., Shanghai 200031, China Bank Draft should be made payable to “Asian Journal of Andrology” and sent to following address: Asian Journal of Andrology, Room 302, Building 16, 294 Tai-Yuan Rd, Shanghai 200031, China. According to Bank of China regulations, there is handling charge of RMB70 for each draft, the cost of which should be borne by the registrant. Please inform the secretariat when the bank draft be sent out.

If you would like to send us Euro, please instruct your bank to use the following payment routing information.

EUR. Intermediary Bank Deutsche Bank, Frankfurt

SWIFT DEUTDEFF

Beneficiary’s Bank in China Agricultural Bank of China, Shanghai Branch, Xuhui Sub-Branch

SWIFT ABOCCNBJ090

Beneficiary’s A/C 033924-00801088453

Shanghai Institute of Materia Medica, Chinese Academy of Beneficiary’s Name Sciences

Beneficiary’s Address 294 Taiyuan Rd., Shanghai 200031, China

E: Accommodation and Tour reservation

The Accommodation and tour program are under preparation, please consult the updated information on 3APFA website (http://www.asiaandro.com/3APFA) or contact the secretariat.

F: Group Registration policy

Letter of Invitation Please contact the Forum Secretariat for an official Invitation letter in order to obtain a visa to

3APFA Secretariat Ms Dan-Qing Ren or Ms Hui Zhang, Editorial Office, Asian Journal of Andrology, 294 Tai-yuan Rd, Shanghai 200031, China Phone: +86-21-5492 2824 Fax: +86-21-5492 2825 E-mail: [email protected]; [email protected]; [email protected] Forum Website: http://www.asiaandro.com/3APFA attend the 3APFA 2009. The 3APFA 2009 secretariat will not directly contact embassies and consulates on behalf of applicants. Cancellation and Refund Policy Cancellation must be notified in writing to the secretariat. Please refer to the following cut-off date for cancellation. All refunds will be made after the Congress for administrative reasons. Bank charges will be deducted from the refunded amount.

Cancellation Before After August 15 After September 1, After received by the August 15, and before 2009 and before September Secretariat 2009 September 1, 2009 September 20, 2009 20, 2009

Registration fee 20% charged 30% charged 70% charged No refund

Contact for Registration: Ms Dan-Qing Ren or Ms Hui Zhang Editorial Office, Asian Journal of Andrology Room 302, Building 16, 294 Tai-yuan Rd, Shanghai 200031, China Phone: +86-21-5492 2824 Fax: +86-21-5492 2825 E-mail: [email protected]; [email protected]; [email protected] URL: http://www.asiaandro.com/3APFA

3APFA Secretariat Ms Dan-Qing Ren or Ms Hui Zhang, Editorial Office, Asian Journal of Andrology, 294 Tai-yuan Rd, Shanghai 200031, China Phone: +86-21-5492 2824 Fax: +86-21-5492 2825 E-mail: [email protected]; [email protected]; [email protected] Forum Website: http://www.asiaandro.com/3APFA