The 5th Shanghai International Symposium on Nonlinear Science & Applications
Shanghai, China, June 27 – July 3, 2012
Registration & Hotel Reservation Form
Personal Particular
Title of Abstract
Title:
Name:
Prof.
Dr.
(First Name)
Gender:
Male
Mr.
(Middle Name)
Female
Passport Number:
Mrs.
Ms.
(Last Name)
Signature
Nationality:
Date of Birth:
Place of Birth:
(m/d/y)
(City/Country)
Affiliation:
Mailing Address:
Country:
Postal Code:
Tel:
Fax:
Email Address:
@
Accompany Family Member
Name:
Gender:
Passport Number
Place of Birth
Name:
Gender:
Passport Number
Place of Birth
Name:
Gender:
Passport Number
Place of Birth
Name:
Gender:
Passport Number
Place of Birth
(First Name)
Male
Female
(First Name)
Male
Female
(First Name)
Male
Female
(First Name)
Male
Female
(Middle Name)
Nationality
Date of Birth:
(Last Name)
(Middle Name)
Nationality
Date of Birth:
(Last Name)
(Middle Name)
Nationality
Date of Birth:
(Last Name)
(Middle Name)
Nationality
Date of Birth:
(Last Name)
(m/d/y)
(City/Country)
(m/d/y)
(City/Country)
(m/d/y)
(City/Country)
(m/d/y)
(City/Country)
 The registration fee is US$620 for a regular participant before the deadline (May 25, 2012). The registered participant is
offered with a copy of program-abstract book, gifts, reception, coffee/tea break, daily meals, banquet,
transportation from Shanghai to Yichang, and five-days accommodation (June 29-July 3, 2012) on the cruise and in
Chongqing.
 The student is charged US$570 before the deadline for a copy of program-abstract book, gifts, reception, coffee/tea break,
daily meals, banquet, transportation, and five-days accommodation. The photocopy of a student ID card should be
presented when she or he registers.
 Each family member accompanied is charged US$570 for gifts, reception, daily meals, banquet, transportation, and
five-days accommodation.
 Financial awards will be available for the students or young researchers who submit works of high quality. For all the
payments after the deadline (May 25, 2012), an extra pay of US$60 for one person is needed.
More information of the
payment is listed below.
A. The total amount of your registration payment:
US$
Brief schedule and information of accommodations in Shanghai
June 27, 2012
June 28, 2012
June 29, 2012
June 30, 2012
July 1, 2012
July 2, 2012
July 3, 2012
Registration and welcoming reception, Fudan University, Shanghai
Plenary talks, Fudan University, Shanghai
A trip from Shanghai to Yichang by express train or by air and then starting the Yangtze
cruise from Yichang to Chongqing
Tour day including a conference banquet on the vessel
A half-day plenary and session talks on the vessel and a half-day tour
A half-day plenary and session talks on the vessel and a half-day tour
Tour day in Chongqing - Approaching the destination city, Chongqing, around 9:00 a.m.
and the accommodation will be arranged by the organizing committee.
 Accommodations in Shanghai will be arranged at Qinyun Building (Zheng Da Development and Management Center) and
Fuxuan Hotel, both of which are the guest houses of Fudan University.
University, which are very near to the venue.
discounted only for the conference.
They are located in the main campus of Fudan
The conference will provide the participants with a special rate for rooms,
The price for a Standard Room (double room or twin room) is US$70 per night (including
breakfast).
I shall book a Standard Room at the guest house of Fudan University before the Yangtze Cruise
from June
to June
, for total
nights.
I will attend the one-day tour of Chongqing on July 3.
I need accommodation arrangement in Chongqing on July 3.
I shall book
express train
flight
for
persons
from Chongqing back to Shanghai on July
.
This transportation expense is not included in the registration fee.
I shall book a Standard Room at the guest house of Fudan University after the Yangtze Cruise
from July
to July
, for total
nights.
B. The total amount of your housing payment:
US$
C. The sum of registration and housing fees ( C = A + B ):
US$
Payment By
Bank Transfer
Bank Draft or Check
Tentative Date (by the first two payment means):
Pay Cash or Using Credit Card on Desk
(m/d)
Note:
All the payment should be paid to Ms. Jiang Lihua, the Financial Secretary of the Organizing Committee of Shanghai NSA
2012. More information of the payment is available on the next page.
MEANS OF PAYMENT:
All payment including registration fee, accommodation and excursions should be made in US dollars or equivalent Euro or
Japanese Yen by one of the following means:
(1) Bank Transfer:
Account Number:
31001544900055655174
Account Name (Beneficiary):
Shanghai Society of Nonlinear Science
Bank: China Construction Bank, Shanghai Branch,
Yangpu Sub-branch.
Attn: Ms. Jiang Lihua, the Financial Secretary of the
Organizing Committee of Shanghai NSA 2012
Swift address of the bank: PCBCCNBJSHX
(2) Bank Draft or Check to:
“Ms. Jiang Lihua, the Financial Secretary of the
Organizing Committee of Shanghai NSA 2012”
Secretary, Shanghai Society of Nonlinear Science
School of Mathematical Sciences, Fudan University
220 Handan Road, Shanghai 200433, P. R.China.
Note: The words “Ms. Jiang Lihua, the Financial
Secretary of the Organizing Committee of Shanghai NSA
2012” must be written on your check or draft.
(3) Pay Cash or using Credit Card at:
The Shanghai NSA 2012 registration desk, during
registration time, June 27-29, 2012.
TRAVEL TO FUDAN UNIVERSITY IN SHANGHAI:
It is very convenient for the visitors to arrive in Shanghai. There are two international airports in Shanghai. The direction
for approaching Fudan University could be found at http://ccsb.fudan.edu.cn/snsa12/th.html
Please return this filled form directly to the Organizing Committee before May 15, 2012, either via the
email (snsa@fudan.edu.cn) or via the fax +86-21-6564-6073.