8th Biennial Meeting of The Asian-Pacific Society for Neurochemistry |
PAYMENT AUTHORIZATION FORM
Payment by Credit Card: For authenticity of your signature, this last page should also be faxed to (86-10) 51386717. Necessary signatures to come into force
I hereby authorize China International Conference Center for Science and Technology (CICCST) to debit the below mentioned credit card account with the total value of the items booked by me stated in this form, for the 8th Biennial Meeting of The Asian-Pacific Society for Neurochemistry.
Values to Be Debited for:
Registration Fee:
US Dollars
Hotel Deposit:
Chinese Yuan
LT/EP Tickets:
Chinese Yuan
Post Tours:
Chinese Yuan
Total: US$
x 1.04 =
US dollars
CNY
x 1.04 =
Chinese yuan
The payment is for (name(s) of delegate(s))
Card Name:
VISA
MasterCard
American Express
Card Number:
Expiration Date (month/year)
Name of Card Holder:
Card Holder's Fax/Email (in case problem in payment arises):
Card Holder's Signature:
Date of Signing:
Note: Sometimes credit card companies reject our request for payment; some place a limit on the amount of payment. In both cases, we will inform you as soon as possible.
please print this form and fax frist,then click submit button.Please FAX this form to (+86-10) 58677828, attention: Miss Milina Han, Link International. APSN2008, Link International, Room 2605/06, Floor 26, No.1 Building, Time International Plaza, No.6 ShuGuangXiLi, Chaoyang District, Beijing, P.R.China Post Code: 100028 |