PRELIMINARY PROGRAM

Registration Form, CIT2012
Pre-registration Deadline: February 16, 2012
China Interventional Therapeutics (CIT) 2012
March 15-18, 2012 China National Convention Center, Beijing, China
Congress Secretariat
CIT 2012 Secretariat
CMA Meeting Planner
Chinese Medical Association
42 Dongsi Xidajie, Beijing 100710, China
Tel: +86 10 8515 8473
Fax: +86 10 6512 3754
Email: lfdai@citmd.com
How to Register
Return the form with full payment to the
Congress Secretariat. Those paying with credit
cards may fax the form to +86 10 6512 3754.
Faxed forms are considered originals - DO NOT
mail a duplicate copy. Pre-registration ends on
February 16, 2012. Thereafter, registration will
be processed on-site only. Please read the
information on the left before you fill out the
form.
Confirmation Letter
Confirmation Letter with your registration
number will be sent upon receipt of your
registration form. Please inquire if confirmation
does not reach you 6 weeks after your
sending.
Invitation Letter / Visa
An invitation letter and a visa notice form
will be issued to facilitate your visa application
upon request. It does NOT imply any
financial commitment.
On-Site Registration Schedule
March 14, 2012 08:00-18:00
March 15, 2012 08:00-17:30
March 16, 2012 07:30-17:30
March 17, 2012 08:00-17:30
March 18, 2012 08:00-11:30
Lobby, China National Convention Center
Cancellation Policy
Up to February 16, 2012 50% refund
After February 16, 2012 No refund
(1) Registration may be transferred to
another person
(2) The Policy applies to cancellation for
registration ONLY.
Bank Account
Intermediary Bank’s Name:
First Union National Bank
New York International Branch
SWIFT code: PNBPUS3NNYC
Beneficiary’s Banker’s Name:
DengShiKou Branch, Bank of Beijing
SWIFT code: BJCNCNBJ
Account Name:
Chinese Medical Association
Account Number:
01090342701420109000210
I. Participant (Print your name as you wish it to appear on your badge)
1. Prof. Dr. Mr. Ms. Other
Given Name:
Family Name:
Organization:
Please send me an Invitation for Visa Application,
my Passport Number is:
Nationality:
I do not need any Invitation for Visa application, thanks.
2. Please staple your business card to the Form if it reflects your correct contact
information. Otherwise, please print below:
Mailing Address:
City/State:
Country:
T el:
(incl. country & city code)
II. Accompanying Persons or Children
Email:
Zip:
Fax:
1. Mr. Ms. Mrs.
Passport Nr. :
2. Mr. Ms. Mrs.
Passport Nr. :
3. Mr. Ms. Mrs.
Passport Nr. :
III. Registration
Up to February 16,
2012
After February 16,
2012
Full Participant RMB3,200 RMB3,600
Nurse RMB1,600 RMB1,800
Student RMB2,400 RMB2,800
Acc. Person RMB1,600 RMB2,000
# of People Cost
*
Pre-registration ends on February 16, 2012. Please register on-site thereafter.
Total:
* A verification letter of fellow/student is required for those who wish to register in this status.
IV. Payment
All registrations must be accompanied by valid credit card information, a bank draft or a
copy of Bank Remittance. The Congress will not be responsible for any bank charges.
1. Credit Card: □ American Express □ Master Card □ Visa □ JCB
Card Number:
Expiration Date: / (mon./year)
Cardholder s’Name
Cardholder s’S ignature:
(Please Print):
Date:
Approximately 4% bank charge will apply and the transaction will appear under the name of CYTS ONLINE on your next statement.
2. Bank Draft:
Please draw a bank draft (with your full name and address indicated on the back)
payable to CIT2012 and mail it with the Registration Form to the CIT2012 Secretariat
3. Bank Transfer:
Please transfer your registration fee to the Congress Bank Account (see left).
S ignature:
Date:
http://www.citmd.com
Please make one photocopy of this form for your own reference!