Offline Registration Form Early Bird on or before 27 August 2012

Offline Registration Form
Early Bird on or before 27 August 2012
(For Enquiry: icdsc2012@momentousasia.com)
Please use ONE FORM for EACH REGISTRATION and separate forms for multiple registrations.
A.Personal Particulars: * must be completed
Title:*
Surname/Last name:*
Given/First Name:*
Prof Dr  Mr Ms Mrs
Affiliation(University, Company):*
Address:
Zip Code:
Telephone:*
Country:*
Fax:
Email:*
Paper ID(One full registration rate is allowed to upload one
paper)
* Do you require vegetarian food?

Yes

IEEE Member No:
ACM Member No:
No
B. Registration Fees is converted at exchange rate USD1=HKD7.8, author and paper presenter must select
to register on IEEE/ACM Member or Non-member. One full registration rate is allowed to upload one paper:
IEEE/ACM Member
Non-member
IEEE/ACM Student member
Student non-member
Before
August 27, 2012
After
August 27, 2012
□USD550/HKD4290 □USD650/HKD5070 □USD385/HKD3003 □USD455/HKD3549 □USD650/HKD5070 □USD750/HKD5850 □USD455/HKD3549 □USD525/HKD4095 C. Additional Paper ID (for IEEE/ACM Member, Non-member):
□USD200/HKD1560 X 1 paper
□USD200/HKD1560 X 1 paper
□USD200/HKD1560 X 1 paper
□USD200/HKD1560 X 1 paper
1)
2)
3)
4)
Total Payment:
HKD/USD
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Early Bird on or before 27 August 2012 Hong Kong Regional time
(For Enquiry: icdsc2012@momentousasia.com)
D. Additional Item (exchange rate USD1=HKD7.8): Additional reception ticket Additional Banquet with Tour ticket USD30 / HKD234 x ( ) Ticket(s) = USD / HKD USD100 / HKD780 x ( ) Ticket(s) = USD / HKD Conference registration entitles you to:
● Admission to all technical sessions and tutorial
● Conference Proceedings
● Welcome reception
● All coffee breaks and lunches
● Regular (non-student) registration also includes a ticket to the conference tour and banquet
E. Cancellation and Refund Policy
Refunds requested before 27 August 2012 will be subject to a USD100 processing fee; No refunds will be
possible after that date. Note that refunds are not possible for authors of published papers. This is because
registration is a prerequisite for the publication of an accepted paper.
A written notification is required in case of cancellation after registration is confirmed
F. Payment Method (Please  the appropriate payment method)
By Credit Card  VISA
 MASTERCARD
 AMEX
Name of Card Holder
Expiry Date (MM/YY)
Credit Card Number
Holder’s Signature
Card Verification Number :
(the last three digits at the back of your VISA/Master card,
applicable for VISA/Master only)
Grand Total: HKD ____________
(USD1=HKD7.8)
I hereby authorize “Momentous Asia Travel & Events Co. Ltd” to charge the grand total amount to my credit card
above. Information provided is true and correct to the best of my (our) knowledge.
Before we proceed your payment , please make sure:

Your card is allowed to make payment overseas.

Your visa or master card must be verified by Visa/Master.

Your card has the credit limit for the payment.
By Telegraphic Transfer:
Please transfer the payment into the following account:
Name of Account :
Momentous Asia Travel & Events Company Ltd
Bank :
HSBC Hong Kong
Account Number :
400-715389-838 (multi-currency including CNY)
Bank Address :
HSBC Main Building, 1 Queen’s Road Central, Hong Kong
SWIFT Code :
HSBCHKHHHKH
* In order to avoid any inconvenience, please state “ICDSC 2012” and the participant name in the message of the
remittance.
* Please fax the completed Offline Registration Form to (852) 2369 2060 or email to icdsc2012@momentousasia.com
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