REGISTRATION FORM (3rd ICDEA, Sept 1--5, 1997, Taipei)
Please, print or type
TITLE:(Please circle) Mr. Mrs. Dr. Prof. Jr.
FAMILY NAME: ________________ FIRST NAME: _________________________
MAILING ADDRESS: __________________________________________________
__________________________________________________
TELEPHONE:(with country code) ____________________________________
FAX:(with country code) __________________________________________
E-MAIL: __________________________________________________________
BADGE INFORMATION (please limit to 35 characters):
NAME TO APPEAR ON BADGE: _________________________________________
GUEST BADGE: _____________________________________________________
NAME(s) OF ACCOMPANYING PERSON(S): _______________________________
ACCOMMODATIONS:
I would prefer (please circle
one): Single Room Twin Room
at ACTIVITIES CENTER OF ACADEMIA SINICA, TAIPEI
between AUGUST 30 and SEPTEMBER 6.
If you wish to share accommodation with another participant,
please indicate name(s): _________________________________________
ARRIVAL DATE:______________ ARRIVAL FLIGHT and TIME:_____________
DEPARTURE DATE:____________ DEPARTURE FLIGHT and TIME:___________
PS: If your stay period is
outside the period Aug. 30-Sep. 6
and if there is no rooms at Activities Center, we will provide
the hotel information for you.
I AM INTERESTED IN MORE
INFORMATION CONCERNING POST
CONFERENCE TOURS (please circle one): YES NO
SIGNATURE:________________________________
DATE:_________________