Confirmation of payment details.doc

Confirmation of payment details 费用支付确认表 Innovative Business in China “创新型企业在中国”研讨会 EFMD CEIBS China Conference, Beijing 29 – 30 November 2012 北京，2012年 11月29-30日 PLEASE RETURN TO: 请将回执发传真或电邮至以下联系人 Claudia Schaefer, Deputy Director Dean’s Office, CEIBS Email: cschaefer@ceibs.edu Fax: +86-21-2890-5114 Phone: +86-21-2890-5675 Joyce Wang, Administrative Assistant Dean’s Office, CEIBS Email: wjoyce@ceibs.edu Phone: +86-21-2890-5141 PARTICIPANT’S DETAILS 个人信息： Title称谓: Dr/Mr/Mrs/Ms/Prof First name名: ????? 博士/先生/夫人/女士/教授 Family name姓: ????? Company Name / Institution公司/机构:????? Registration date注册日期:???? Registration number注册编号: ? Total Amount of registration fee for conference and accreditation seminars需交 注册费及研讨会费用总金额: ???? Payment Method 支付方式： 1. By Credit Card 信用卡支付（Recommendation 推荐） I authorise a debit to my credit card (please tick one): Visa MasterCard American Express 我授权给以下信用卡（请选择信用卡种类）： Please indicate the currency: USD EURO 请指明支付币种： Card number 卡号:????? Card security code安全码:?????Expiry date有效期: ????? Cardholder’s Name持卡人姓名:???? ? Signature 签名: Date日期: 2. Telegraphic transfer 银行转帐至: （Transfer fee is not included in the registration fee 请自理转账可能产生的手续费） Bank details for payment in USD 美元帐号信息 Bank Name? : China Merchants Bank Shanghai Branch Nanxi Sub-branch Bank Address : 100 Nanjing Xi Road, Shanghai, China A/C Name?? : China Europe International Business School A/C Number ::: 211580425132001 Swift Code?? : CMBCCNBS Bank details for payment in RMB 人民币帐号信息 开户银行 : 招商银行上海分行南西支行 银行地址 : 上海市南京西路100号 账户名称 : 中欧国际工商学院 帐号????? ?: 211580425110002 Bank details for payment in EUR 欧元账号信息 A/C Name?????????? : China Europe International Business School A/C Number???????: 211580425135001 Bank Name???????? : China Merchants Bank Shanghai Branch Nanxi Sub-branch Ba