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: : PERSONAL DETAILS
First Name
Affiliation / University :
Will Attend to Give Presentation (Yes/No) Participate in the FIELD TRI P : ( Yes / No ) Address Details Street 1 : Street 2 : Number : City : Country : Other Information :
Email Address :
Price ( Rp ) b
Rp 920.000 Rp 1.400.000
Duratio n (Days) c -
Number of person d
Confirm ( Rp ) bxcxd
Rp 150.000 Rp 300.000
FIELD TRIP PARTICIPATION** Tour Rate for Single Occupancy BANK TRANSFER FEE Attention : All Bank Fees should be paid by participant COST FOR TRANSPORTATION (U-BUS)*** From Taoyuan Airport to Hsinchu From Hsinchu to Taoyuan Airport
Rp 160.000
Rp
Rp 85.000 Rp 85.000
TOTAL PAYMENT
Rp
BANK ACCOUNT - US$ ACCOUNT Name: Bank: Branch: US$ Account: EMAIL US After you completed the (1) Payment Form, and (2) Transfer Slip, please confirm us before February 15, 2012 by: Email : With Attachment of Payment Form and Transfer Slip to aisc.taiwan@gmail.com Attn : AISC-Taiwan 2012 Conference Manager NOTE : * If you are a student in Taiwan now, you only need to pay NT$ 500 Astri Dwijayanti Suhandoko BCA Tanjung Priuk 0073130694
** If you want to join the itinerary (field trip), please let us know. It costs USD 18, Rp 160.000,00 or NT$ 500 [for student in Taiwan, please pay your registration & itinerary payment via AISC-Taiwan 2012s treasurer (Account number: 0051224 0063283, On behalf of: , Puspa Julistia Puspita, Bank Name: Taiwan Post Office)] *** For the conference day, AISC-Taiwan 2012s Committee will provide you a free pick up service from the hotel to the venue.