/ The 5th International Conference on Systematic Innovation July 16-18, 2014
Registration Form

Registration ID (office use):

Paper ID(s) if any: Gender:□Male□Female

Name:(last), (first) , (mid), (Chinese name, if any)

Affiliation:

Position: E-mail:

Address:

City:______Zip Code:______State/Country: ______

Tel: Fax:______Cell Phone:______

Name(s) of accompanying guest(s):

Note: 1) Each paper must have at least one author registration. Regular registration includes conference banquet.

2) One form for each person. Paper ID is not required for non-authors.

3) One author registration fee covers two papers. If more than 2 papers, half additional registration fee will cover up to two additional papers.

(To select, replace□ with ■ at selected locations)

A. Registration Fees
Class / Fee / No. of Purchases / Total
Regular Registration / (with 10% discount for code “IEEE-SF”)
- Authors / □Regular (Aft. 2014/07/01) US$ 350 / US$
□Early (Bef. 2014/06/30) US$ 315 / US$
- Non-Authors / □Regular (Aft. 2014/07/01) US$ 450 / US$
□Early (Bef. 2014/06/30) US$ 405 / US$
- Full-time Student (or spouse) / □Regular (Aft. 2014/07/01) US$ 200 / US$
□Early (Bef. 2014/06/30) US$ 180 / US$
□Attending Banquet US$ 45 / US$
One-day Pass (includes tutorial on that day) Indicate Date:
□ 7/16; □ 7/17; □ 7/18; / □Regular (Aft. 2014/07/01) US$ 180/day / US$
□Early (Bef. 2014/06/30) US$ 162/day / US$
□Attending Banquet US$ 45 / US$
Payment before or on June 30, 2014 can enjoy the “IEEE-SF” 10% discount. Total: US$
B. TutorialOnly
Classes / Fee / No. of Purchases / Total
Tutorials(Can attend any or all of the 3 tutorials.) / □Regular (Aft. 2014/07/01) US$ 150 / US$
□Early (Bef. 2014/06/30) US$ 120
Total: US$
Grand Total: / USD:
Discount/Priority Code / Final Amount:
Special Requests to the conference Organizers:

Payment Methods:

  1. Banktransfer(Send, facsimile, or e-mail this form with a copy of the cash remittance noteto
    Conference Secretariat)

Account:The Society of Systematic Innovation

Bank Name:Mega International Commercial BANK
Account No:020-09-10136-1

SWIFT Code:ICBCTWTP020
Bank code：017-0206

Bank Address: No.1, Hsin-an Rd., HsinchuSciencePark, Hsinchu City30076, Taiwan (R.O.C.)

  1. Credit Card(Fill in the following information and FAX this form to Conference Secretariat)

VISA / Master/ JCB/ AMERICAN Cardholder Authorization Letter

Country:

Personal and Card Information

First Name: / (as it appears on card) / Middle Name(S):
Last Name: / (as it appears on card)
Date of Birth: / Date of Birth (day /month / year)
/ / / Expiration Date: / (month / year)
/
Card Type: / □VISA □MASTER □JCB
Card Number: / □ □ □ □ -□ □ □ □ -□ □ □ □ -□ □ □ □
Security Code: / □ □ □ / Start Date: / □ □ □
Issue No:
Amount Authorized
Item(s) Purchased / □Registration fee: The 5th International Conference on Systematic Innovation Amount: $______
□Other. $ ______.Specify: ______
Special Message

Address

Address Line 1: / This must be your residential address. We can’t accept P.O Boxes.
Address Line 2:
Town/City:
State/Territory:
Postcode:

Please Sign your name here ______

as the same as the signature on your card