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Payment Form by Credit Card by huangyuarong


									                                                 ANNEX I
ANNEX I        International Conference on Talent Development and Excellence
                                    April 19-22, 2012, Beijing, China

                                     Payment Form by Credit Card
Please fill in the blanks and return this form to:

Ms. Chunhong Yan
Secretariat of Talent
Center for International Scientific Exchanges, CAS, 52 Sanlihe Rd., Beijing 100864, China
Phone: +86-10-68597772, Fax: +86-10-68597748, Email:

Re: Payment of ______________________________ (Attendee’s full name)

I would like to make the payment for the registration fee by Visa MasterCard

(Payment by Credit Cards will be charged in RMB and an additional 4% service fee will be charged by
banks from your card. Exchange rate: 1 USD = 6.4RMB)

Credit Card No.: _________-_________-_________-_________ Expiry Date: ______/______ (MM/YY)

Card Holder: __________________________________
I consent to the Center for International Scientific Exchanges, CAS debiting my credit card for the amount of
USD________________ plus around 4% service charge to Bank of China.

Signature card holder: ________________________________                Date: __________________________

(Signature should be the same as that appears in the signature box at the back of your credit card.)

Please attach a clear copy of your credit card with both front and back sides, we required the cardholder’s
signed authorization below to process this payment. (You can make a photocopy or scan one)

If you cannot offer the copy of your credit card, please tick:

□ I cannot attach the copy of credit card; I will take responsibility for any result of this payment without the
copy of the credit card.

                                                                      Copy of the back side of the Credit Card
                                                                 (You can cover the security code by a small sheet
     Copy of the front side of the Credit Card
                                                                 of paper on the back copy of your card before you

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