4th ASS & S lecturer/Speaker Registration Form
If Chinese, Chinese Name (中文姓名)
Passport No. (ID number, if Taiwanese)
(Male / Female)
Affiliation/ Institute/ University
Title (Student/ Engineer/ Researcher/
Cellular Phone, if applicable
Intend to give a lecture? (Y/N)
III - Particle Acceleration
If yes for line 17, choose a session I - Laser Science (Y/N) II- Plasma Physics (Y/N)
Intend to give a conference talk? (Y/N)
If yes for line 19, provide a title of the talk.
Arrival Date, Time
Arrival Airline, Flight Number
Number of Companion?
Airport pickup? (Y/N)
Departure Date, Time
Departure Airline, Flight Number
Hotel to airport transportation? (Y/N)
Date of ASS hotel check in, if different
from line 21
Date of ASS hotel check out, if different
from line 25
Vegetarian diet? (Y/N)
Bring a laptop computer?(Y/N)
Lecture-note media preference: ___ CD, ____ Hardcopy (3-hole binder), ___ Electronic file download
1. _____ I am willing to pay a
3. _____ I must apply a
voluntary registration fee of 2. _____ I prefer not to
Voluntary Registration Fee (Check one) financial support to defray
USD$________ to help others attend pay any registration fee.
my air travel to this event
* Passport and Birthday infomation are for domestic insurance purpose
*Those who intend to a lecture in the school or to give a oral presentation in the symposium will be recommended to the International
Curriculum and Program Committee for a decision on granting invitation.
* Lectures and Speakers will be arranged to rooms with single occupacy.
V - Laser-plasma
IV - Radiation Physics