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International Symposium on Fluorous Technologies (ISoFT’11)
Hong Kong · 30 November – 3 December 2011
REGISTRATION FORM (INDUSTRY)
(to be returned by 1 September 2011 for early registration)
*********************************************************************
Name: (*Prof/Dr/Mr/Ms/Miss/Mrs)
First Name
*Please delete as appropriate
Surname
Affiliation:
Address:
Tel:
Fax:
E-mail:
Vegetarian:
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 No
Special Requirements:
Payment
Registration Fees:  US$540 (before 1 September 2011)
 US$600 (after 1 September 2011)
I authorize City University of Hong Kong to charge the amount stated below from
 VISA CARD
 MASTER CARD
Credit Card Number:
Name of Cardholder:
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Transaction Amount:
US$
or HK$
Signature of Cardholder:
Note:
Personal cheques will not be accepted.
If payment is made by credit card, this form must be signed and returned to the Symposium Secretariat,
Department of Biology and Chemistry, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon,
Hong Kong, or by facsimile to (852) 3442 0522.
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