Last Name*: First Name*:

Gender: Male Female Position: Professor Postdoc, Research Associate Research Assistant Student Others

Affiliation*:

Address*:

Phone:

Fax:

E-mail* (Please enter Only One E-mail addr.):

An one-day excursion to the northern seashore of Taiwan will be
arranged on May 7, 2008. Please provde the following information
for the insurance purpose.

Passport No.*             Birthday(mm/dd/yyyy) *
                 

* - Required.

II. Travel Schedule and Food Requirement

Arrival Date:

Departure Date:

Special requirement on food (vegetarian or no pork, ...) :

III. Companion

Please provde the following information of your companion(s) 
for the insurance purpose.

    Last Name    First Name        Passport No.           Birthday(mm/dd/yyyy)
1.                   
2.                   
3.                   

V. Remark or additional note: