Confirmation and Payment Notice

R e gistration form

HKIA 2012 Taipei Field Trip

Attn: HKIA Secretariat (Email: [email protected]) (Please reply by 17 August 2012)

Address: HKIA Secretariat, 19/F, One Hysan Avenue, Causeway Bay, Hong Kong

Tentative Cost HKIA member about HKD5500 (Twin-sharing room basis): Non-HKIA about HKD6000 member

I / I and my accompanied person* confirm my/ our* participation in the HKIA Taipei Field Trip. Please find my (and my accompanied persons’) details as follows:

(中文) (Eng) Gender: *(Same as Passport) HKIA Member no.: Day Time Contact:

Organization/Company:

Email:

Passport No: Valid Date: Emergency Contact (Tel & Name)

Name of Accompanied Person (1) (中文) (Eng) Gender: *(Same as Passport) HKIA Member no.: Day Time Contact:

Organization/Company:

Email:

Passport No: Valid Date: Emergency Contact (Tel & Name)

(A) Payment method

Deposit HK$2500

I would like to settle the deposit by: (Please tick as appropriate)

(1) By cheque ( )

(Cheque Payable to “The Hong Kong Institute of Architects”)

Enclosed please find a crossed cheque of HK$______(Cheque number:______Bank:______).

(2) By bank transfer ( )

For ATM payment, please send email to the Secretariat [email protected] for the bank account number.

(B) Room Preference

I would like to have:

 single room throughout the trip of HKIA 2012 Taipei Field Trip*.  shared twin room with ______throughout the trip of HKIA 2012 Taipei Field Trip* My accompanied person (1) would like to have:

 single room throughout the trip of HKIA 2012 Taipei Field Trip *.  shared twin room with ______throughout the trip of HKIA 2012 Taipei Field Trip* * Please delete as appropriate.

Signature: ______Date: ______