THERMAL STRESSES 2007 Credit Card Authorization Form
June 4-7, 2007, Taiwan, R.O.C

* First Name    :

Middle name :

* Family Name :

* Reg .  No   :

I would like to pay the above total by Credit Card
(Please fill out the following form)

Card Type: VISA    Master Card    JCB

Card No.:            -                -                -        

Three digit security code on the back of the card:     
(信用卡背面末三碼 - 請務必提供)
Expiration Date:
(Month/ Year)
 

Credit Card Issuing Institution:

Credit Card Issuing Country:

Card Holder’s Name:

Total Amount:

Authorized Signature:


(Must match signature on the back of the card)

Date:

Please fax to the THERMAL STRESSES 2007 Secretariat
TEL No.:886-2-2362-8136-47    FAX No.:886-2-2363-2090
Contact name:Tso ren