PARTICIPATION INFORMATION
(download word file)

Please multicopy and fill out the following form. As a reply e-mail ONE FORM FOR EACH OF THE PARTICIPANTS OF YOUR DELEGATION to the APhO Office address apho@phy03.phy.ntnu.edu.tw or mjlin@phy03.phy.ntnu.edu.tw.
Alternately fill out the form with BLOCK LETTERS and fax it to +886-2-2930-7124.
Send the form as soon as possible, please no later than March 25.

1. COUNTRY:                                                                                       .

2. STATUS:                                                                                           .
                    ( Leader / Pedagogical leader / Student number (1...8) /Observer /Visitor)

3. NAME: (Family Name)                                     .

                (First Name)                                     , (Middle Name)

4. GENDER:                                      .
                      (Female/Male)

5. BIRTHDAY:                                     .
                         (Day - Month - Year)

6. PASSPORT NUMBER:                                                .

7. TELEPHONE IN CASE OF EMERGENCY:

8. LANGUAGE USED IN THE EXAMS: _________________

9. SWEATER SIZE: _______________________
                                (Medium / Large / Extra Large)

10. DIET: _____________________________
                (Vegetarian / No Pork/ No Beef/ Other(please specify)

11. ANY FURTHER INFORMATION:____________________________
                        (Illness/ Deficiency/Allergy/Other that organizer should know)

12. ARRIVAL: _____________________________________
                        ( Airlines / Flight Number / Time(hour-day-month)

13. DEPARTURE: _______________________________
                             ( Airlines / Flight Number / Time(hour-day-month)

14. REMARKS: