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泛珠三角中醫藥論壇暨展覽 論壇/工作坊登記表格 PAN-PEARL RIVER DELTA FORUM AND EXHIBITION FOR CHINESE MEDICINE Registration Form for Forum/Workshops 所有資料請以中文英文如適用)填寫Chinese and English (if applicable). 此表格可網上下載: .mo/chinese_med 登記資料 Registration Details 此欄由承辦單位填寫 For Executive Organizer Use Only 機構編號 Organization No.: 機構名稱 Organization 中文in Chinese 英文in English 地址 Address 中文in Chinese 英文in English 電話 國家號碼 Country Code 區域字頭 Area Code 號碼 Number 傳真Fax 電郵E-mail 網址Website 聯絡人Contact Person 姓 Family Name 名Given Name 移動電話 國家號碼Country Code 號碼 Number 住宿Accommodation 參加者自行安排住宿 Delegates will make their own accommodation arrangements. 請提供酒店訂房資料 Please provide information about hotel bookings. 登記及付款截止日期 Registration Payment Deadline 2005 / 05 / 10 填妥表格後，請電郵/傳真/郵寄回承辦單位： Upon completion of this form, please return it to the Executive Organizer by email / fax / mail: 澳門生產力暨科技轉移中心 論壇/工作坊登記表格 PAN-PEARL RIVER DELTA FORUM AND EXHIBITION FOR CHINESE MEDICINE Registration Form for Forum/Workshops 費用Fees 每名參加者的會務費用Fee per Delegate 數量Quantity 金額 Amount MOP / HKD / RMB** 500.00 X = MOP / HKD / RMB** ** 請將不適用者刪去Delete whichever is inapplicable 付款Payment 請選擇下列其中一種方式付款 Please choose one of the following payment methods: 銀行匯款 (請在遞交登記表格時附上銀行匯款的記錄) By Bank Remittance (Please enclose bank remittance record when submitting your registration form.) 銀行名稱 Bank Name: 中國銀行澳門分行 Bank of China, Macau Branch 銀行地址 Bank Address: 澳門蘇鴉利士博士大馬路中國銀行大廈 Avenida Doutor Mário Soares, Bank of China Building, Macau 帳號 Account Holder: 澳門生產力暨科技轉移中心 Centro de Produtividade e Transferência de Tecnologia de Macau SWIFT地址 SWIFT Address: BKCHMOMX 澳門幣帳號 Account No. for remittance in MOP: 01-012-078606-5 港元帳號 Account No. for remittance in HKD: 01-112-384220-8 銀行本票(HKD)或支票(MOP)，抬頭寫「澳門生產力暨科技轉移中心」 (請在遞交登記表格時附上銀行本票 /支票 By Bank Draft (HKD) or Cheque (MOP), made payable to “CPTTM” (Please enclose bank draft/cheque when submitting your registration form.)