CREDIT CARD PAYMENT REQUEST FORM

           Workshop Name: The 7th Workshop on Accelerator Operations

           Dates: April 11 ~ 16, 2010

           Print Name on Credit Card                     

           Participant's Name if different from credit card                     

           E-mail Address                     

           Credit Card Number                     

           Card Security Code*                     

           Expiration Date                     

           Registration Fee (KRW)                     

           Signature for credit card approval                     

           * The card security code(CDC) is a 3- or 4-digit number printed in the signature field on the back of your credit card.
           Payment by credit card should be required to fax this form with signature.

           REGISTRATION FEE

Before February 15, 2010	KRW 300,000
After February 15, 2010	KRW 380,000

           The registration fee covers a copy of the workshop program and an abstract book, the welcome reception, the workshop
           banquet, the tour and lunches at the KAERI cafeteria.

Please fax it to +82-42-868-8131
ATTN : bspark@kaeri.re.kr           download