TASTA Taiwan Science-based Industrial Parks Tour

華府科技訪問團

Registration Form 報名表

click here to download Word format file

Name	Dr./Mr./Ms./ ___				M.D./Ph.D./J.D./_______
Name (Taiwanese)		Age (Optional) ______			___Male   ___Female
Home Address
City				State & Zip
Home Phone				Cell Phone
Email address(es)				FAX
Company/Organization
Address
City			State & Zip
Work Phone			FAX
Email address(es)
Education
Experience & Expertise
Interests
Office Use ONLY	Member No. __________________			Received Date

Send this form along with a check of $70 payable to TASTA to:

TASTA, 10806 Hillbrooke Lane, Potomac, MD 20854. FAX:501-638-2106. Thank you!