Registration Form

1. All information in this form will be treated as confidential and will be used exclusively by Tongji-SEM-IEDP.

2. No Payment is due until you have received confirmation of your admission. Once notification of Admission is received, payment is due 15 days before the beginning of the Workshop and refund - in case of a non-show - is limited to 50% of the fees of the Module.

3. Please keep this page open until you have finished registrating to ALL Modules you are interested in.

A. Personal Information
*Surname :   *Given name :  
Name (Chinese) :   Gender :    Mr.
Date of Birth (YYYY/MM/DD):   *Nationality :  
*Mobile phone in China :   Land Telephone (China) :  
Mobile phone out of China :  
*email address :  
Job Title :  
Number of years in this Job :   Number of employees you are responsible for :  
Preferred language of Modules :    English
Are you Tongji Alumni ? :    Yes, please specify your School/Faculty and class    No
Highest Education :    PhD      Master/MA      EMBA/MBA      Bachelor/BA      University (no degree)      College      Non available
B. Company Information
Company Name :  
Company Name in Chinese :  
Province :   Postal Code :  
Address :  
Address in Chinese :  
Industrial Sector :  
Aerospace Automotive Business (consulting & Services) Chemicals
Cosmetics Electronics Finance, Banking & Insurance Food & Beverage
Government Hospital Hotels & Tourism IT & Hi-Tech
Manufacturing Materials Media & Culture Mining
Oil Paper Pharmaceutical & Healthcare Power & Power equipment
Real Estate & Infrastructure Retail & Wholesale & Trade Telecommunication Textile/Garment/Leather & Fashion
Transportation & Logistics Other - please specify
Company type :    State Owned Entreprise (SOE)      Fully Owned Foreign Entreprise (FOFE)      Government Agencies      Joint Venture with Foreign investment      Private Entreprise      Other - please specify
the HR Manager or the Executive responsible for Management development in your organization/company
Name (Chinese) :   Gender :    Mr.
Job Title :  
Business Telephone :   Internal line :  
Business email :  
C. How Do You Learn about Us
Internet Search Engine (please specify which):  
Specialised Web-sites (please specify which):  
Social Netowrk (please specify network/group):  
Chamber of Commerce (please specify which):  
Fellow Alumni (please specify Alumni Association):  
Work Connections :  
My boss My Colleagues My Employees
Word of Mouth :  
Family Friends (other than fellow alumni or work colleagues)
Other (please specify):  
D. Registration for Tongji-SEM-IEDP Module
Title and Code of Module Dates (YYYY/MM/DD) Number of seats
Tongji-SEM-IEDP Research to Business (R2B) Platforms 2015/01/09 - 2015/01/11
Total Number of Seats 99280