First name:

Last name:

Organization/Camp:

Address:

City:

Prov./State:

Postal/Zip Code:

Country:

Office phone:

Mobile phone (with country code) : +

Email:

Fax:

[ I accept that my information (full name, organization, country and email) be included in the list of participants     

£ YES    £ NO

£ Welcome Dinner (October 8) and Symposium (October 9 day, including dinner)

+) USDxxx X _____ person =

£ Excursion (October 10 and 11): Dashyeshan National Forest Recreation Area and Campground design competition

+) USDxxx X _____ person =

£ Optional excursion (October 12, including lunch) : Sanyi woodcarving town

                        +) USDxxx X _____ person =

(A) Regular Registration fee:

£ Early Bird Discount: 20% off of (A) if your registration and fee are received in full before June 30, 2009

            -) (A) x 20% =

(B) Early Bird Registration fee:

£ Student Discount: 20% off of (A) or (B) if you are able to show a valid student identification upon arrival.                       

-) (A) or (B) x 20% =

(C) Student Registration fee:

£ Single room addition : If you select to own one room and do not share the room with another participant, you pay USDxxx more per night.

+) USDxxx X _____ night =

£ Lodging Deduction : If you have your own lodging arrangement, please deduct lodging expense.

        -) USDxxx X _____ night =

(D) Actual Registration payment:

Selective tour on the night of October 9:

£ Feeling like a Taiwanese - walking through the Shinlin night market

                              Free X _____ person =

£ Reaching the top of the world – view from the observatory of Taipei 101 

                        +) USDxxx X _____ person =

£ The program at the National Concert Hall (program and price to be announced when available)

       +) USDxxx X _____ person =

£ The program at the National Theater (program and price to be announced when available)

           +) USDxxx X _____ person =

0

(E) Selective tour payment

                                                                                                                 Total payment = (D) + (E)

Cancellation Policy

Cancellation of registration received before August 15, 2009 will be refunded in full, less USD50.00 processing fee. Cancellation received after August 15, 2009 is non-refundable.

　

Methods of payment - **Please register on line. If you pay by credit card, send this registration form with credit card information and signature by fax to +886-2-xxxx-xxxx. If you pay be bank transfer, please fax the bank slip along with the registration form to +886-2-xxxx-xxxx.

Credit card payment : £ Visa**   £ MasterCard

Credit card number:                                                                                  Expiration date (mm/yyyy):

Credit card holder: (Please print)                                                               Registration date:

Card holder’s signature (Mandatory):

Bank transfer

Bank name:

Bank address :

Account name :

Account number :

Bank SWIFT code :

Health information and special needs

Blood type: £ A  £ B  £ O  £ AB

If you join the Dashyeshan excursion, please check if you have ever had the following diseases. The excursion will take you to an altitude from 2,200 meters to 2,700 meters.

£ Heart diseases

£ altitude sickness/acute mountain sickness (AMS)

Check if you are allergic to any of the followings, if yes, please specify.

£ Food, specify __________________________________________________________________________________

£ Medicine, specify _______________________________________________________________________________

£ Others, specify _________________________________________________________________________________

Please specify needs for religious ceremony:

Vegetarian : £ YES   £ NO

Other special needs:

____________________________________________      ______________________________________________

               Participant Signature                                        Date (dd/mm/year)

Contact informatiN

3^rd AOCC Organizing Committee

Department of Civic Education and Leadership,

National Taiwan Normal University

162, He-ping East Road, Section 1, Taipei 10610, Taiwan

Phone: +886-2-xxxx-xxxx / Fax: +886-2-xxxx-xxxx

Email: xxxx@xxxx.edu.tw

Web site: www.3rdaocc.org.tw