<p> R e gistration form</p><p>HKIA 2012 Taipei Field Trip</p><p>Attn: HKIA Secretariat (Email: [email protected]) (Please reply by 17 August 2012)</p><p>Address: HKIA Secretariat, 19/F, One Hysan Avenue, Causeway Bay, Hong Kong</p><p>Tentative Cost HKIA member about HKD5500 (Twin-sharing room basis): Non-HKIA about HKD6000 member</p><p>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:</p><p>Name:</p><p>(中文) (Eng) Gender: *(Same as Passport) HKIA Member no.: Day Time Contact:</p><p>Organization/Company:</p><p>Email:</p><p>Passport No: Valid Date: Emergency Contact (Tel & Name)</p><p>Name of Accompanied Person (1) (中文) (Eng) Gender: *(Same as Passport) HKIA Member no.: Day Time Contact:</p><p>Organization/Company:</p><p>Email:</p><p>Passport No: Valid Date: Emergency Contact (Tel & Name)</p><p>(A) Payment method</p><p>Deposit HK$2500</p><p>I would like to settle the deposit by: (Please tick as appropriate)</p><p>(1) By cheque ( )</p><p>(Cheque Payable to “The Hong Kong Institute of Architects”)</p><p>Enclosed please find a crossed cheque of HK$______(Cheque number:______Bank:______). </p><p>(2) By bank transfer ( )</p><p>For ATM payment, please send email to the Secretariat [email protected] for the bank account number.</p><p>(B) Room Preference</p><p>I would like to have:</p><p> 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:</p><p> 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. </p><p>Signature: ______Date: ______</p>