Registration

Personal Information
Last Name
First Name
Affiliation
Dietary Needs
Address
Address (Optional)
Address (Optional)
Country
Email
Telephone
Registration Fee
 
ATVA 2005 ONLY
ATVA/FORTE 2005 Package
  On or Before 1 September After 1 September   On or Before 1 September After 1 September
Participant $350 USD $400 USD Participant $500 USD $600 USD
Student $200 USD $250 USD Student $320 USD $420 USD
Payment Information  
Credit Card Type VISA MasterCard JCB
Credit Card Number
The last 3 digits on the signature panel:
Credit card issuing bank:
Expiration (month/year)
Exact Name (of Card Owner) on Card
Signature
_____________________________________________________________________________________________
Comments (e.g., title on the print receipt)
Notes:
(1) The registration includes one copy of the preceedings, the opening reception, and banquet.
(2) Cancellations are subject to a $100 USD administrative charge.
(3)You have to fill out this form, print it, sign it, and mail or FAX it to:
Prof. Yih-Kuen Tsay
Department of Information Management
National Taiwan University
No.1, Sec. 4, Roosevelt Road, Taipei
106-17, Taiwan
FAX: +886-2-33661199