第29届世界音乐教育大会境外媒体记者报名表
Registration Form for Journalist of ISME 29th World Conference
基本信息Basic Information
姓/Last Name:名/First Name:证件照片/Photo
中文姓/Chinese Last Name if Applicable:
中文名/Chinese First Name if Applicable:

出生日期/ Date of Birth:
_______年/YY_____月/MM_____日/DD 性别/Gender: 男/M 女/F
国家/地区 Country/Region:
出生地/Place of Birth:
国家/地区 Country/Region)城市/city)
护照号码/Passport NO:
有效期至/Valid until:_______年/YY_____月/MM_____日/DD
所属媒体/Represented Media:
媒体英文名/English Name of your Media if Applicable:

工作部门/ Department:
媒体所在国家/地区 Country/Region of your Media:

媒体所属类型/ Type of Media:
报纸/Newspaper 杂志/ Magazine 电视/ TV 广播/ Radio 图片社/ Photo Services 通讯社/ News Agency
其它/Others(please specify)
记者类别/ Type of Journalist:
文字/ Reporter 摄影/ Photographer 摄像/ Cameraman
其它/Others(please specify)
申请人采访身份:常驻中国记者/Resident Foreign Correspondent 记者证号/Card Number:
记者站所在地/Address of Agency:
临时来华记者/Visiting Journalist
签证信息Visa Information
申请来华前往地点/Places You Have Applied to Visit
地点/Visiting Place:
领取签证使(领)馆/Embassy That Issued Your Visa:

拟入境日期/Intended Date of Entry:: 2010 年/YY_____月/MM_____日/DD 拟出境日期/ Intended Date of Exit:
2010 年/YY_____月/MM_____日/DD
是否申请过赴华签证/ Have you ever applied for a Visa to enter China before?
是/Yes 否/No
是否被拒绝过来华签证/ Has your application for a Chinese visa ever been declined?
是/Yes 否/No
被拒时间/ If yes, when:_______年/YY_____月/MM_____日/DD 地点/where:
身体健康状况是否良好/Good health? 是/Yes 否/No
有何疾病/ If No, please give details
联系方式/ Contact Information
工作地址/ Work Address:
办公电话/ Office Phone: 移动电话/ Mobile Phone:
传真/ Fax: 电子邮箱/E-mail:
其他联系方式/ Other Means of Contact: