Fourth International Conference on Weigh-In-Motion ICWIM4 20-23rd February 2005 Taipei, Taiwan
REGISTRATION FORM Please complete and return this form to: Chinese Institute of Civil and Hydraulic Engineering ICWIM4 Fax: +886-2-23964260 With written signature Or E-mail:
[email protected] With electronic (scanned) signature Please complete all blanks in type.
1. Personal Information □ Delegate
(Please tick)
First Name:
Family Name:
First name as you would like it to appear on badge: Title (Prof. / Dr. /Mr. / Ms.): Company/ Organisation / University: Mailing Address:
E-mail Address:
@
Fax: Tel: If paper author, specify Paper(s) No(s):
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□ Student First Name:
Family Name:
First name as you would like it to appear on badge: Title (Prof. / Dr. /Mr. / Ms.): University: Mailing Address:
E-mail Address:
@
Fax: Tel: If paper author, specify Paper(s) No(s):
□ Exhibitor
(Please tick)
Company/ Organisation / University: Person 1 First Name:
Family Name:
First name as you would like it to appear on badge: Title (Prof. / Dr. /Mr. / Ms.): Mailing Address:
E-mail Address:
@
Fax: Tel: If paper author, specify Paper(s) No(s):
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Person 2 First Name:
Family Name:
First name as you would like it to appear on badge: Title (Prof. / Dr. /Mr. / Ms.): Mailing Address:
E-mail Address:
@
Fax: Tel: If paper author, specify Paper(s) No(s):
□ Accompanying person
(Please tick)
First Name:
Family Name:
First name as you would like it to appear on badge: Title (Prof. / Dr. /Mr. / Ms.): Mailing Address:
E-mail Address:
@
Fax: Tel:
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2. Registration Fee Delegate □
Early Bird Registration Fee, US$350, before 15th December, 2004
□ Regular Conference Fee, US$450 (Please tick) The delegate registration fee covers: : please tick what you will attend - Attendance to all conference sessions and exhibitions - All coffee breaks during the conference - Sunday Evening Reception (20th February)
- Monday Evening Banquet (21st February)
- Pingsi Heavenly Lantern Festival Tour on Tuesday evening (22nd February) - All lunches during the conference - printed pre-proceedings + post-conference CD
Student (must be full- time student) (Please tick)
□ Registration Fee, US$80 The student registration fee covers: - Attendance to all conference sessions and exhibitions - All coffee breaks during the conference
- Sunday Evening Reception (20th February) - All lunches during the conference - printed pre-proceedings + post-conference CD
□ Banquet, US$50 □ Pingsi Heavenly Lantern Festival Tour, US$40
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Accompanying Person □ Registration Fee, US$150 The accompanying person registration fee covers: please tick what you will attend - Sunday Evening Reception
- Monday Evening Banquet
- Pingsi Heavenly Lantern Festival Tour on Tuesday evening - All lunches during the conference
□ Taipei City One Day Scenery Tour, US$80 One day tour to National Palace Museum and hot spring SPA on Monday
□ Banquet, US$50 □ Pingsi Heavenly Lantern Festival Tour, US$40 (Please tick)
Exhibitor □ Stand rental, US$1350 □ Booking/registration fee, US$300 Preferences for exhibition booths will be awarded on a “first-come-first-served basis” based on the date of receipt of the deposit. The exhibitor registration fee covers: - Two full registrations of delegates - The Exhibition Booth and necessary accessory
Do you want to receive an invoice? □ yes
□ No
(Please tick)
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3. Payment Means □ Credit card
□ Bank transfer
(Please tick)
(1) For Credit Card Payment Credit Card Information
First Name: Last Name: Card Type:
□ VISA
□ MasterCard
□ JCB
(Please tick)
We regret that AMERICAN EXPRESS cannot be accepted.
Card Number:
-
-
-
Card Verification Number: VISA
MasterCard
Expiration (MM/YY):
/
Signature: The signature must be the same as the signature on the credit card.
The Amount of Money:
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(2) For Bank Account Payment Bank Account information
Taipei Bank Taipei, Taiwan SWIFT BIC: TPBKTWTP200 Account Number: 200102422103 Name: China Road Federation Address: 2 Fl., 184 ChangAn E. Rd., Sec.2, Taipei, Taiwan 104, R.O.C.
First Name: Last Name: The Amount of Money: The Date and Time You Pay the Fee:
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