REGISTRATION FORM
(Registration Deadline: 01 October 2014)
Prof.
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Dr.
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M.Sc.
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B.Sc.
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Eng.
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Undergrad. Student
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First/Given name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Last/Family name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Affiliation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Affiliation address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Phone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Fax: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Email: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Please check the applicable boxes:
I will attend the 4S-2014/AVIC 2014 Conference and submit a paper:
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I will attend the 4S-2014/AVIC 2014 Workshop, but do not submit a paper:
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FEES AND PAYMENT INFORMATION
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Until October. 1, 2014
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After October. 1, 2014
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Regular Participant
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300 USD
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350 USD
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Student
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250 USD
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300 USD
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Companion
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50 USD
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100 USD
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Send completed application form with appropriate payment by email or Fax. Countersigned contract will be returned upon approval.
4S-2014/AVIC 2014
Attn: Nguyen Thi Kim Chi
Email: chi.nguyenthikim@icdrec.edu.vn
Fax: +84(8) 37 242 172
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Bank Accounts Information (International payments)
Beneficiary:
IC Design Research and Education Center (ICDREC)
Beneficiary Address:
7th Floor VNU Main Office Building, 6th Quarter, Linh Trung Ward,
Thu Duc District, Ho Chi Minh City, Vietnam.
TEL +84(8)37 242 171
Bank Account:
Bank Name : Vietnam Joint Stock Commercial Bank for Industry and Trade (VietinBank)
Branch : Thu Duc Branch
Bank Address : 1 Vo Van Ngan Street, Linh Chieu Ward, Thu Duc District,
Ho Chi Minh City, Vietnam
SWIFT : ICBVVNVX 947
Account No. : 102020000060773
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