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					1. Please make sure that you complete each part of this registration form with reference to the guideline and information on the webpage for confe
2. Please delete the sample when filling out the form.




        A. Personal information


  xy

                                          Passport number
         Title First Name   Family Name    (ID number for        Organisation                 Address                 Country
                                          Taiwan citizens)



SAMPLE Mdm.      Cindy          Lin           123456789      breast cancer foundation                                  Taiwan
ion on the webpage for conference registration, and do not change any format of it. In case of any inquiry, please contact the conference secretariat at reist@rea




                                                                               Mobile                Fax
                             Date of birth
             Postal code                     TEL(country code+number)         (country            (country                 Email
                           (dd/mm/yyyy)
                                                                           code+number)        code+number)



                 105         10/10/1965            886-2-2751-1909         886-0910-166-666    886-2-2751-1769   regist@reachtorecovery.org
TOTAL FEE FOR THE GROUP: USD________
nference secretariat at reist@reachtorecovery2011.org.


                                                              Main registrant


                                                                                              B. Travel details


                                                  special dietary requirements

              Function at conference
                (delegate, speaker,                                                            Arrival date and flight   Departure date and flight
                                           Vegetarian         Special mobility requirements
              commmittee member)



                     delegate
                                                                            D. Additional events, including social function
C. Emergency contact
                                                                            information.)




     Full name         TEL(country code+number)        Fax          Email            Pre-conference




       Emily                     Lin              886-2-2751-1909
, including social functions (Please refer to the special program section of the conference website for more
                                                                                                                       A. Personal information


                                                                                       Cultural tour booking
                                                                               (Please number your preference in the

                   Welcome reception                    Gala dinner            Route Route Route Route Route           First name   Last name
                                                                                 1     2     3     4     5


                                                                                                                         1. Nate      1.Lin
                                                                                                                          2.Den       2.Lin
                                                                                     Accompanying person


information                                                                                                B. special dietary requireme




                                  Date of birth
              Passport number                     Email   TEL(country code+number)   Fax          Mobile   vegetarian
                                (dd/mm/yyyy)



                 1.123456789      1.11/12/1977                                                                1.Yes
                 2.987654321      2.03/09/1979                                                               2. N/A
                                                                                                                                   Fee calculation (please indicate th
                                              C. Additional events, including social functions (Please refer to the
B. special dietary requirements               special program section of the conference website for more                                Registration fee calculation
                                              information.)

                                                                                                                         USD300       USD 450
                                                                                                                       (Early bird    (Regular
             speacial mobility requirements     Pre-conference      Welcome reception            Gala dinner          registration- registration-
                                                                                                                        (Before 30 (After 30 June
                                                                                                                       June 2011))     2011))


                                                       V                    V                         V                    1            N/A
e calculation (please indicate the number of persons in the cell)


  Registration fee calculation                        Social function fee




             USD 150/day      USD 180/person       An additional fee of USD 70
              (One-day        (Accompanying        for gala dinner is applicable
             registration)        person)             to one-day participnat



                 N/A                 1                         N/A

				
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