Pacific Cultural Foundation Application Form

1. Sponsoring institution ___________________________________________________
   
   Name of school ________________________________________________________
   
   Address ______________________________________________________________
   
   Tel. _______________________________ Fax. ______________________________
   

   (with area code)

   
   

2. Name __________________________________ Age___ Sex___ Nationality________
   

   (last)

   (first)

   (middle)

   (Chinese)

   Position ______________________________________________________________
   
   Institution _____________________________________________________________
   
   Education ____________________________________________________________
   
   Mailing address _________________________________ Tel. ___________________
   
   Home address __________________________________ Tel. ___________________
   
   

3. Seminar Title:
   (Chinese) _____________________________________________________________
   
   (English) _____________________________________________________________
   
   ____________________________________________________________________
   
   
4. Proposed period and place: _______________________________________________
   
   
5. Nature and organization of the seminar: ______________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   
6. Proposed subject and purpose of the seminar: __________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   
7. Main speakers: ________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   
8. Participants (total number _________________________________ ):
   
   

   Nationality	Number	Nationality	Number
   ___________________ ___________________ ___________________ ___________________	_____________ _____________ _____________ _____________	____________________ ____________________ ____________________ ____________________	_____________ _____________ _____________ _____________

   
   

9. Amount of cost to be provided by the participants or other sponsor:
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   _____________________________________________________________________
   
   
10. Applicant's total estimate (please itemize):
    
    
    
    
    
    
    
    
    
    
    
    
    

Date __________________ Signature of Seminar Director ____________________________

*Please use the remainder of this form or additional pages to amplify any answers.