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Your Position：Home Registration Online Registration
REGISTRATION FORM

PERSONAL INFORMATION

Title:

Family Name:

First Name and Initial:

Position and Affiliation:

Contact Address:

 (Street, City and Zip Code)

Country:

E-mail:

Fax:


REGISTRATION FEE

Category

 Until Jun 30, 2008 After Aug. 1, 2008 Subtotal

Participant

 US$650 US$700 Person:     
Accompanying Person US$200 US$200 Person:     

 

     Total(1):US$

PASSPORT DATA FOR VISA INVITATION(Participant and Accompanying Persons)
Date of Entry into China

 

Date of Exit from China

 

City of Chinese diplomatic mission from which to get visa:

 

Name in Passport    Nationality    Occupation    Passport Number    Date of Expiry    Sex        Birth Date



HOTEL RESERVATION (please type over where necessary)

Check-in Date

Check-out Date

 

Category

Room Rate
Per room/night

Breakfast

 

Building 1(Newly Renovated)

Five Star Standard one bed

RMB ￥1160

One

Building 1(Newly Renovated)

Five Star Superior one bed

RMB ￥1360

One

Building 1(Newly Renovated)

Five Star Suit one bed

RMB ￥1580

One

Building 2

Four StarStandard Room two-bed

RMB ￥ 640

Two

Building 3

Three StarStandard Room two-bed

RMB ￥ 560

Two

Building 4(Newly Renovated)

Four Star Standard Room two-bed

RMB ￥ 770

Two

Hotel Deposit US$100         Total(2): US$

GRAND TOTAL:(1)+(2) =US$ = CNY

PAYMENT:
I wish to pay a total amount of US$ by:
Bank transfer in US dollars to Banking Department, Bank of China Head Office, 1 fuxingmen Nei Dajie, Beijing 100818, China, Account Name: CICCST, Account no. 00038018091014, S.W.I.FT.: BKCHCNBJ
Please indicate your name and "EMWME 2008" on all money transfers.

I wish to pay a total amount of US$ x 1.04 = US$ (CNY ) by
Credit Card
I hereby authorize CICCST to debit the below mentioned credit card account with the total value of the items booked by me on this form.
Card Name: VISA Master Card American Express
Card Number:
Expiration Date (month/year)
Name of Card Holder:
Card Holder's Fax/Email (in case problem in payment arises):
Card Holder's Signature: Date of Signing:

Note for Payment: Payment in US Dollars for registration fee and hotel deposit will be converted to the Chinese yuan according to the currency exchange rate of the day when the money is received. A four percent bank charge should be added to the payment by credit card.

    

Download Payment Authorization Form



2008 East Meets West In Medical Education Tel:010-82800012 Fax:010-82800885
Email:info@emwme.org.cn