Registration Form s19

Registration Form s19

<p> WCEE 2008 Beijing October 12-17, 2008 Beijing, China Registration Form</p><p>Please complete this form and return it to: Staff use only Ms. Yu SHEN, CICCST/14WCEE Registration No.: 86 Xueyuan Nanlu, Beijing 100081, China _____ Fax: +86-10- 62174126</p><p>Please type or write clearly in block letter. </p><p>PERSONAL INFORMATION </p><p>Family Name ______First Name ______Sex:  Male  Female </p><p>Institute/Affiliation ______</p><p>Mailing Address: ( Office  Home) Street Address ______</p><p>City, Zip Code, State/Province ______Country______Paper ID: ______</p><p>E-mail ______Tel. ______Fax </p><p>PASSPORT DATA FOR VISA INVITATION (Participant and Accompanying persons) </p><p>Name in Passport: Family Name First Name Nationality Occupation Passport No.</p><p>Participant: ______</p><p>Accompanying Person (1) ______</p><p>Accompanying Person (2) ______</p><p>Accompanying Person (3) ______</p><p>You would like your visa to be issued in ______(City) ______(Country)</p><p>Registration Fees </p><p>Category Before After Aug. 1 Person(s) Amount Aug. 1 /QTY Full Registration   US$550 X US$475 Full-time Students   US$320 X Registration US$280 Accompanying Persons   US$250 X US$200 One Day Registration Fee   US$160 X US$160 Extra Paper’s Fee   US$150 X US$150</p><p>Subtotal (1) US$ ______</p><p>Grand Total: US$ ______</p><p>METHODS OF PAYMENT:</p><p> I have remitted the above grand total from my bank ______on (date) ______payable in US dollars (copy enclosed) to Bank of China, Head Office. Address: 1 Fuxingmen Nei Dajie, Beijing 100818, China. Swift code: BKCHCNBJ. Account No.: 00038008091001. The beneficiary is CICCST. I have written ““WCEE’08”” and my name in the place of “Message”. </p><p> I will pay by Credit Card. Please mark:  Visa Card  Master Card  American Express Card </p><p>Please charge my credit card for the above grand total US$______</p><p>Credit Card No. </p><p>Expiry Date (yyyy/mm) </p><p>Name of Card Holder</p><p>Card Holder ‘s Signature ______</p><p>Signature ______Date ______</p><p>Contact: Ms. Yu SHEN, CICCST/ WCEE’08, 86 Xueyuan Nanlu, Beijing 100081, China Fax: +86-10- 62174126 E-mail: [email protected] </p>

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