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.