2011矽谷科技冬令營

1 1 20 美

報 日 界 世 國 矽

營 令 冬 技 科 谷

2011美國世界日報矽谷科技冬令營 世界日報舊金山社繼2010年7月成功舉辦「2010矽谷科技夏令營」後，受到家長及學生一致的讚揚和肯定， 並有許多孩子擠不進有限名額而無法參加。 2011寒假來臨之際，世界日報舊金山社再次結合矽谷在地優勢資源，為兩岸三地的學生提供一個矽谷參觀 學習的精采旅程。依然是全球只招收30名學員，絕不超收，敬請把握報名時間，以免向隅！

主辦 : 北美世界日報、台北聯合報系 贊助 : 矽谷NeuroSky公司 對象 : 高中、大學在校，未來將以電機、資訊、生物科技、能源為志業的青年。 16歲-21歲高一至大三學生。 具備一定的英語聽說寫能力(全民英檢中級以上)。 有校內或課外科技單位活動見習經驗者優先。 提供300-500字中文自我介紹及說明為何參加此冬令營。 需獲家長同意。 時間 : 2011年1月23日至2月5日，共14天。 費用 : 美金5800元(費用包含機票及簽證代辦費)。 報名 : 請洽北美世界日報台灣辦事處, 聯合報系教育事業處。 特色 : 科技的探訪與學習、矽谷科技菁英的交流、人脈的建立與擴展、 英文的練習與應用。

營！

樂冬令 快 個 過 起 一 來，

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World Journal Silicon Valley Technology 2011 Winter Camp

活動內容 一、實用情景會話 我們聘請有豐富活動組織經驗的輔導員帶領學生，以小組型式展開學習討論。 • 針對次日參訪科技公司，博物館等行程，先上網蒐集資料，由輔導員帶領學員學習企業文化背景、 練習英語口語溝通、英文製作簡報等主題式教學。 • 幫助學員有效提升英語聽說寫水準，能直接運用在次日的參訪行程中，使參訪行程更深入、 更多互動、更有學習效果。

二、NeuroSky 三天體驗營 關於NeuroSky : • NeuroSky位於美國矽谷，是一家消費領域生物傳感技術居世界領導者的高科技公司。 主要從事生物信號採集處理、腦機接口(Brain-Computer Interface, BCI)等領域的技術研究和開發。 • NeuroSky腦機接口技術廣泛應用於娛樂、教育、心理、科技、單機及網絡遊戲、玩具、瑜伽等眾多領域。 NeuroSky已和包括從財富100強企業到新興高科技公司，以及眾多名牌高等學府和研究機構在內的用戶， 建立了良好的合作關系。 • 2009年，NeuroSky榮獲TechAmerica 頒發的2009年度消費電子類科技創新大獎。

NeuroSky NeuroSky體驗營的意義： 科技 • 認識最尖端的意念控制技術晶片的原理、目前的發展及未來展望。 • 了解NeuroSky腦波控制技術在保健、醫療、教育、汽車、遊戲等行業中的廣泛應用。 • 體驗NeuroSky最新的科技產品。 • 在工程師的帶領下，親自動手了解 NeuroSky 核心技術 -- 晶片設計的過程。 • 從產品設計師的角度了解User Interface/Behavior，思考改進的空間。 • 聆聽NeuroSky管理階層講解產品的推廣管道、市場策略。

人文 • NeuroSky總裁楊士玉將與學員座談，分享他在美國讀高中、大學、就業、創業，並成為NeuroSky公司總裁的心路歷程。 • 面對面與NeuroSky的年輕工程師交談，了解他們的日常生活及工作，分享他們在NeuroSky工作的樂趣。 • NeuroSky每年都有來自全球各地(美國、印度、日本、中國、歐洲國家等)名校的電機、生物、資訊科系的優秀大學生前往見習， 學員可與他們交流，探索科技發展，建立未來科技人脈。

創造力競賽 – MindWave Applications •經過3天在NeuroSky理論的學習和深入的實踐後，在工程師帶領下，學員將分組，體驗新產品MindWave，擬出改進空間/應用範圍的 提案、並以小組簡報，最後由 NeuroSky的工程師評審團，評選出具有創造力和團隊合作能力的優秀團隊。

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三、矽谷著名企業深度參訪 上午在輔導員的帶領下完成對參訪單位的資料蒐集，並由指導老師解說重點，及簡報中可能用到的各種英 文資料，下午走進矽谷最具科技創新力的企業參觀，與企業負責人或主管交流，了解公司的企業文化、創業心 得、核心技術和最新產品。 •NeuroSky

消費領域生物傳感技術的世界領導者。

2009年，NeuroSky榮獲TechAmerica頒發的2009年度消費電子類科技創新大獎。

•Genentech

美國歷史最久的生物技術公司。

是目前規模和實力僅次於安進(Amgen)的世界第二大生物技術公司。

•Google

全球最大，最著名的搜尋引擎服務公司。也是一家世界級、技術和創新能力全球領先的企業。

•eBay

全球最大的網上交易平臺。

•Microsoft 全球最大的電腦軟體提供商，於1975年由比爾蓋茲創立。 *以上公司視情況，機動安排參訪。

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World Journal Silicon Valley Technology 2011 Winter Camp

四、名人對談 安排學員與來自矽谷科技領袖對談，吸收這些金頭腦最寶貴的經驗，並與矽谷科技青年團體交流，建立未 來科技人脈。 講師及顧問群： •朱感生

聖荷西市157年來首位華裔市議員，曾在IBM服務18年。

•林喬偉

2009年矽谷華美半導體協會會長兼理事會主席。

•張文毅

Atman Hospitality Group 創辦人，全世界第一家LEED黃金等級環保旅館的創始者。

*若前述來賓屆時因故無法參與，將另行安排適當之創投或科技公司主管與學員進行演講、會談等。

五、博物館深度探索 帶領學員走進「全美最棒的科學博物館」領略現代科技知識的奇妙世界，探索美國科技文化發展之源。 • 英代爾博物館Intel Museum • 矽谷創新科技博物館The New Tech Museum • 矽谷電腦科學博物館Computer History Museum • 阿拉米達海軍航空博物館 Alameda Naval Air Museum • 加州科學館California Academy of Sciences

•特別行程安排: 美國勞倫斯柏克萊國家實驗室 Lawrence Berkeley National Laboratory Tour

我們將帶學員走進美國能源部直屬的國家實驗室 -- 美國勞倫斯柏克萊國家實驗室（Lawrence Berkeley National Laboratory，簡稱LBNL）。 在參觀整個實驗室期間，學員有機會看到美國勞倫斯柏克萊國家實驗室 的25個重大科學突破發現項目，還會參觀先進的光源和分子鑄造科技，柏克萊實驗室的納米研究機構等。

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六、名校深度參訪 安排學員走進這些培養了眾多諾貝爾獎得主、科學家、企業家等世界級人才的搖籃，與學校的教授或學生 交流，並有專人全程導覽。此外，我們還將安排美國知名長春藤名校升學顧問，講解如何順利申請美國知名大 學、研究所，並現場解答學生疑問。 •美國史丹佛大學

Stanford University

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了 史丹佛，我來

•加州大學柏克萊分校

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University of California, Berkeley

World Journal Silicon Valley Technology 2011 Winter Camp

七、入住黃金級環保旅館 •目前全球有五棟建築物獲得LEEE的環保認證，有三棟是黃金級認證，蓋雅是第一家旅館建築。 •由華人張文毅創辦經營的GAIA

Napa Valley Hotel & Spa，2007年初在加州知名葡萄酒鄉--納

帕（NAPA）市落成，占地4.6英畝，是全世界第一個獲得「美國綠建築協會」(Leadership in Energy and Environmental Design，LEED) 黃金級認證的旅館，是全球第一家最綠化、最環保的旅館。 •旅館有150個房間，以環保為主旨，採用太陽能發電與節省能源的三菱系統，並以回收材料布置周圍環

境，如回收地毯、低放射物的油漆等。旅館採雨水整合，所有的生態環境，包括草與小樹都是共生體，連洗澡 水也都經過過濾系統到養有天鵝的天鵝湖中。 •張文毅來自台灣，是美國首座環保旅館創辦人。1970年他來到美國定居，目前是「歸真環保集團」董事

長與創辦人。張文毅將面對面與學員分享環保旅館開發理念，並帶學員參觀旅館各項環保設施及節省能源的指 標，從而啟發學員認識環保、綠能產業對未來我們人類居住環境的影響。

八、加州那帕山谷酒莊巡禮 加州是美國農產品的主要產地，那帕山谷獨特的氣候條件和地理位置，孕育了著名的葡萄酒業，以這裏的 葡萄為原料生產的葡萄酒，在世界市場上占有重要地位，那帕葡萄酒（Napa Valley Wines）可以說是家喻戶 曉。 沿那帕山谷中央公路兩旁共有500多家葡萄莊園，每個莊園都有自己不同的特點，遊客可以走進葡萄園參 觀，瞭解葡萄栽培的技術。還可以走進紅酒釀造廠房，瞭解葡萄酒釀造的過程。葡萄莊園的餐廳可以提供各種 風味美食，還可以在葡萄園裡野餐，享受田園風光與葡萄美酒的浪漫情趣。

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結業証書核發 學員圓滿完成冬令營項目所有學習及參訪行程，由主辦單位世界日報，及NeuroSky公司聯合授予「2011矽 谷科技冬令營結業證書」。

住宿地點 舊金山皇冠假日飯店 (Crowne Plaza San Francisco International Airport) 位置資訊： • 這間飯店座落於機場附近的Burlingame市，十分方便，靠近Poplar Creek高爾夫球場以及水晶泉高爾夫 球場。 飯店特色： • 皇冠假日飯店為4星級飯店，附設室內游泳池、SPA 池以及健身設備。 • 公共區域提供無線上網服務 (費用另計)。 客房特色： • 客房附有37吋平面電視，並提供付費有線電視頻道以及付費電影。 • 客房提供有線寬頻上網 (需另付費)、直撥電話、CD 播放機以及語音信箱。 • 睡床搭配舒適加層墊床墊以及名牌寢具。所有客房均設有書桌和人體工學座椅。 • 客房設有咖啡機/沖茶器。浴室設有浴缸及淋浴設備 (二合一)、美妝鏡、吹風機以及免費盥洗用品。 • 其他服務設施包括恆溫空調、空調以及客房保險箱。

GAIA Napa Valley Hotel & Spa 蓋雅納帕谷環保旅館

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World Journal Silicon Valley Technology 2011 Winter Camp

遊覽行程 舊金山發現之旅 舊金山是一個與亞洲貿易往來頻繁的商業中心，亦是灣區金融中心，坐落於分隔太平洋與海灣的半島末 端。這個如詩似畫般的城市，興建於陡峭的斜坡上，世界級的餐廳、爵士club、精品店、劇院和咖啡屋，皆近 在咫尺。 世界聞名的旅遊景點包括；舊金山電車、金門大橋、漁人碼頭、中國城、金門公園、電報山和名店匯集的 聯合廣場。 此外，舊金山也有世界級的博物館、交響樂團、歌劇院和芭蕾舞團，及一流的動物園、水族館、天文館、 大名鼎鼎的Ghirardelli巧克力工廠、Cannery罐頭工廠、Cost plus漁人碼頭和39號碼頭的國際商業購物區， 也是不能錯過的景點。

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哈囉，舊金山

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報名及收費 費用: • 美金5800元(費用包含機票及簽證代辦費) 。 • 報名時請繳交1000美元訂金，餘款請在報名後的15天內繳清。未在期限內繳交餘款者，不予保留席位。

費用包括: • 包含機票、燃料稅、機場稅、兵險費及簽證代辦費。 • 包含15天營隊期間的學費、課程材料、食宿以及旅遊的交通、門票、餐費等。 • 活動期間投保旅遊平安保險及每名學員25萬美元意外及醫療保險，以確保學員的權益。 • 學員報到當天，將獲贈本營隊精心製作的紀念T恤、背袋及精美小禮物。

費用不包含: • 護照費及簽證費。 • 行程外的私人活動及個人消費，例如: 私人洗衣，電話，飲料及行李超重等。 • 行程中未涵蓋之費用。

退費規定: 證件繳交及繳清尾款後，除合約另有約定者外，學員因故未能出國或參加本活動，需由家長以書面通知主 辦單位，費用退還方式如下： • 於原定冬令營開始日期30日前取消參加且通知主辦單位者，主辦單位得收取40%之活動費用， 退還家長百分之60%之費用。 • 於原定冬令營開始日期20日前取消參加且通知主辦單位者，主辦單位得收取百分之80%之活動費用， 退還家長20%之費用。 • 於原定冬令營開始日期前10日至1日前取消參加且通知主辦單位者者，主辦單位得收取90%之活動費用， 退還家長10%之費用。 • 於原定冬令營開始日期或之後取消參加者，或中途退出者，或未通知主辦單位者，一律不退費。

報名及繳費方式: 報名申請: 即日起受理報名，截止日期為2010年12月24日。 Step1: 報名時需先繳交1,000美元訂金，可採美金支票(抬頭：WORLD JOURNAL SF LLC)或匯款繳費，請將 美金支票或繳納完成之收執影本，連同報名表(含A4書寫文件)、家長同意書、身分證影印本、護照影印本、英 文檢定證書(如有)、校內/課外科技單位社團活動或見習經驗證明(如有)，一併以親繳、郵寄、Email或傳真之 方式送達至台北聯合報系世界日報台灣辦事處。 聯 絡 : 台北聯合報系世界日報台灣辦事處 李小姐 電 話 : (02)8692-5588轉2751

手 機: 0935-080209

傳 真 : (02)8643-3526 李小姐收

Email : rebecca.lee@chinesenews.com Step2. 簽訂合約並將訂金之外餘款，於指定日期前繳清，未繳清者，視同放棄。 Step3. 開始辦理出國手續及申請手續等作業。 Step4. 參加行前說明會(家長及學員)。 Step5. 組團出發。

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World Journal Silicon Valley Technology 2011 Winter Camp

匯款方式 美金支票支付： • 抬頭：WORLD JOURNAL SF LLC

電子匯款支付(美金)： • 收款人: World Journal SF, LLC • 帳號(account no.):04123-76083 • 名稱(beneficiary): World Journal SF, LLC • 地址:231 Adrian Road., Millbrae, CA94030 • 電話:650-692-9936 • 受款銀行(Full Name of Bank):Bank of America • 銀行代號(Routing Number of Bank): ABA 121000358 • 銀行代碼Account with inst.(Swift Code of Bank):BOFA US 3N • 地址(Address of Bank): 701 Grant Avenue, San Francisco, CA 94108 U.S.A

台幣支票支付 • 抬頭：聯合報股份有限公司

電子匯款支付(台幣)： • 銀行： 台灣銀行 松山分行 • 帳號： 064031000029 • 戶名： 聯合報股份有限公司

附:相關表格 2011「世界日報矽谷科技冬令營」報名表 2011「世界日報矽谷科技冬令營」參加同意書 *若需中文表格請與各地服務人員聯繫。

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2011 World Journal Silicon Valley Technology Winter Camp Participation Agreement _______________ (Student’s parent or legal guardian, a.k.a. parents) agree to allow my child(ren) to participate in the 2011 World Journal Silicon Valley Technology Winter Camp (Winter Camp), organized by World Journal SF, LLC. and United Daily News Group (Organizers), from January 23, 2011 to February 5rd, 2011, and also agree to comply with the following terms and provisions of the contract: Parents have read and understood all of the brochures, forms, and other documents relating to the Winter Camp, and have no objections to the terms and previsions contained within. Parents also agree to have their child(ren) abide by the rules set by the Organizers during the course of the Winter Camp.

Parents agree to pay all required fees in the form of checks or electronic transfer to the specified World Journal account on or within two weeks of the application date.

The enrollment quota of the Winter Camp is limited to 30 students. In case the maximum enrollment is reached, admission will be decided in the order of full remittance of fees. Organizers will not reserve slots for students who fail to remit all required fees on or within two weeks of the application date. Organizers will stop accepting applications when the Winter Camp reaches its maximum enrollment capacity. If the total enrollment does not reach 20 students by Dec 24, 2010, the Winter Camp will be canceled, and the students and their parents will be notified of the cancellation. In such occasions, all fees, except for visa application fees will be refunded.

Parents agree to provide truthful information in all required forms and documents. Parents will be held liable for any misrepresented or dishonest information.

Parents agree that their child(ren) is in general good health to participate and complete all Winter Camp programs and activities. Parents agree to notify the Organizers of any special health conditions, including but not limited to, chronic disease, allergies, etc. Child(ren) with poor health conditions or those who have difficulty taking public transportation for a long period of time may not be suited for this Winter Camp.

Child(ren) who requires special living or dining accommodations must notify the Organizers in writing.

Organizers will coordinate with the third party providers to provide appropriate accommodations for the child(ren) to the best of its ability, although certain limitations may apply based on child(ren)’s individual circumstances. Organizers reserve the right to deny participation to child(ren) who fails to meet the health standards, or if no appropriate accommodations can be made to meet the specific needs of the child(ren).

The Organizers will assume no liability in the case of injury, illness, or death if parents fail to comply with the provisions stated above. Parents may not request reimbursement for medical expenses or refund of the tuition fees from the Organizers or any third party providers.

If, due to the reasons stated above, Organizers must deny the participation of the child(ren) before the start date, parents will be notified and all fees will be refunded.

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World Journal Silicon Valley Technology 2011 Winter Camp

If the Winter Camp needs to be canceled due to unanticipated natural hazards including, but not limited to, earthquakes, wild fire, and disease that may threaten the life, well-being, and/or financial security of the students, the contract will be void and the entire sum of tuition minus the administrative/visa processing fees will be refunded to the parents.

Parents understand and agree that the Organizers may be unable to end the program on scheduled time, or unable to fully comply with the scheduled programs due to external circumstances that may pose threat to life and well-being of the students. Under such scenarios, Organizers may be forced to alter the programs to the best of its ability based on necessity. In addition, parents agree to pay for the cost of lodging and living expenses for their child if the program is unable to end on anticipated date due to external circumstances and the students must remain in United States for more than 2 days after the scheduled end date. If payment is first made by the Organizers, parents agree to refund the organizers within five working days after their child(ren) returns to home country .

Certificate of Completion will not be issued to students who miss more than half of the Winter Camp programs.

If the student is unable to attend the Winter Camp due to personal or any other reasons except for those described under provision 5 of this contract, the refund schedule will be as follows: 1.Cancellation with proper written notification to the organizers 30 days prior to the Winter Camp start date – 40% of the total fees will be charged as processing fees by the organizers, the remaining 60% of the fees will be refunded.

2.Cancellation with proper written notification to the organizers 20 days prior to the Winter Camp start date – 80% of the total fees will be charged as processing fees by the organizers, the remaining 20% of the fees will be refunded.

3.Cancellation with proper written notification to the organizers 10 days prior to the Winter Camp start date – 90% of the total fees will be charged as processing fees by the organizers, the remaining 10% of the fees will be refunded.

4.No refunds will be made to ones who cancel participation or drops out from the program on or after the official start date of the Winter Camp.

THE PARTIES AGREE THAT THE REFUND SCHEDULE SET FORTH ABOVE PROVIDE REASONABLE LIQUIDATED DAMAGES UNDER AND IN CONNECTION WITH THIS AGREEMENT. IN CONNECTION WITH THE FOREGOING, THE PARTIES RECOGNIZE THAT ORGANIZERS HAVE INCURRED EXPENSES IN CONNECTION WITH THE AGREEMENT AND THAT IT IS EXTREMELY DIFFICULT AND IMPRACTICABLE TO ASCERTAIN THE EXTENT OF DETRIMENT TO ORGANIZERS CAUSED BY LATE CANCELLATION. THE PARTIES SPECIFICALLY AGREE THAT THE REFUND SCHEDULE SET FORTH ABOVE IS A REASONABLE ESTIMATE OF THE COSTS, EXPENSES, LOSSES, AND OTHER DAMAGES THAT ORGANIZERS WILL SUSTAIN AS A RESULT OF PARENTS’ LATE CANCELLATION, INCLUDING WITHOUT LIMITATION COSTS OF MAKING ADVANCED ACCOMDATIONS FOR STUDENTS, COSTS

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OF SEEKING ANOTHER STUDENT TO REPLACE THE CANCELLING STUDENT, OPPORTUNITY AND ADMINISTRATIVE COSTS, AND OTHER LOSSES SUSTAINED AND/OR COSTS INCURRED IN CONNECTION HEREWITH. ORGANIZERS’ RETENTION OF THE LIQUIDATED DAMAGES AMOUNT IN SUCH CIRCUMSTANCES SHALL BE ORGANIZER’S SOLE AND EXCLUSIVE REMEDY UNDER THIS AGREEMENT. THE FOREGOING REFUND SCHEDULE IS INTENDED TO CONSTITUTE LIQUIDATED DAMAGES TO ORGANIZERS PURSUANT TO SECTION 1671 OF THE CALIFORNIA CIVIL CODE. THE PARTIES SPECIFICALLY ACKNOWLEDGE THEIR AGREEMENT TO THE FOREGOING LIQUIDATED DAMAGES PROVISION BY INITIALING THIS PARAGRAPH IN THE SPACES PROVIDED BELOW:

________________________

________________________

In case refunds must be made to the parents according to previous provisions, Organizers agree to make the refunds within a month after the completion of the Winter Camp.

Parents consent that if student does not arrive at airport on time and therefore fails to leave the country, and is unable to join the Winter Camp halfway, student will be considered to have dropped out from the program, and the Organizers have the right to claim damages from the students and their parents.

Parents agree and authorize the teachers and personnel to manage, instruct, and guide the words and conducts of all students in order to maintain order and to protect health, safety, and overall interest of all participants. If the student fails to follow instructions resulting in injury or death to him/her or others, Organizers will assume no liability for damages.

Parents agree that, in order to maintain the quality of teaching and classroom discipline, the Organizers retain the right to refuse non-teaching staffs including parents, to follow the activities of students, and/or to take pictures inside classrooms and visiting locations.

Parents agree that the Organizers retain the property interest to any documents and pictures produced in the course of the Winter Camp, and can only be used to Winter Camp related publications and advertisement. Republication or copying of such materials without the Organizer’s authorization is not permitted.

LIMITATION OF LIABILITY. IN NO EVENT SHALL ORGANIZERS OR ANY OF THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS OR AFFILIATES BE LIABLE FOR ANY CONSEQUENTIAL, INCIDENTAL, DIRECT, INDIRECT, SPECIAL, PUNITIVE, OR OTHER DAMAGES WHATSOEVER ARISING OUT OF THIS AGREEMENT, WHETHER BASED ON CONTRACT, TORT, NEGLIGENCE, STRICT LIABILITY OR OTHERWISE EVEN IF ORGANIZERS HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. NOTWITHSTANDING ANYTHING ELSE IN THIS AGREEMENT, THE MAXIMUM LIABILITY THAT ORGANIZERS SHALL HAVE IS LIMITED TO ANY AMOUNTS ACTUALLY PAID TO

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World Journal Silicon Valley Technology 2011 Winter Camp

ORGANIZERS BY PARENTS. PARENTS ACKNOWLEDGE AND AGREE THAT THE LIMITATION OF LIABILITY SET FORTH HEREIN REPRESENT AN INSEPARABLE ALLOCATION OF RISK (INCLUDING, WITHOUT LIMITATION, IN THE EVENT OF A TOTAL AND FUNDAMENTAL BREACH OF THIS AGREEMENT) THAT IS AN ESSENTIAL BASIS OF THE BARGAIN BETWEEN THE PARTIES.

Parents and Organizers agree to use relevant California laws, statutes, and regulations as the controlling authority in case of any controversies arising from the terms and provisions of this Agreement.

Parents consent by signing this Agreement that any controversy arising from their child(ren)’s participation in the Winter Camp will first be negotiated and mediated with the Organizers in good faith in order to reach a mutual settlement.

The parties hereto agree that all actions or proceedings arising in connection with this Agreement shall be tried and litigated exclusively in the State courts of California, United States.

This Agreement will become effective when the parents sign the Agreement. Original copy of the Agreement shall be retained by the Organizers. Parents shall make and keep a copy of the original before submitting the signed Agreement to the Organizers.

Parties to the Agreement:

Parents (Use Name Stamp): Identification Number:

Address:

Telephone Number:

Student’s Name:

Gender:

M

F

Current School/Grade: Date (MM/DD/YYYY):

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2011 World Journal Silicon Valley Technology Winter Camp Registration Form * A t t e n t i o n : I n d i v i d u a l s w i t h h e a r t p r o b l e m s , a s t h m a , h i g h b l o o d p r e s s u r e , e p i l e p s y, diabetes, and persistent and severe flu, or other serious disease, may not be suitable for t h i s C a m p a n d s h o u l d n o t r e g i s t e r. Vi o l a t o r s s h a l l b e r e s p o n s i b l e f o r t h e i r o w n a c t i o n s .

Chinese Name

Birthday

(Please Print)

Year:

Month:

Gender Blood Type

Day:

2” x 2”Picture

Age

ID Number cm

Height

kg

Weight

Phone Number

Cell Number

E-mail

English Name

(Same as Passport)

Contact Address

□□□

Guardian Name

Relationship

Phone Number

(Office): (House): (Cell):

Emergency Contact

Relationship

Phone Number

(Office): (House): (Cell):

Current School/Grade Clothing Size Dining Preference

Health Condition

Attendance Method Payment Method

15.

(Postal Code)

City

High School/University

□ □ □ □ □ □ □ □ □ □ XS

S

M

Normal

Good

L

Vegetarian

Year/Major

XL

Others, Please Explain:

Chronic illness or other special conditions, please explain:

(Note: May require doctor verification)

□ □

Group

Check

□ □

Independent

Wire Transfer

□ □ Mail

In-Person

World Journal Silicon Valley Technology 2011 Winter Camp

III. Please use A4 size grid papers to complete the following documents, and attach to the registration form.

1.A personal statement describing yourself (300 – 500 words).

2.A brief statement on why you wish to attend the World Journal Silicon Valley Technology Winter Camp.

Note: 1.Information provided in the registration form will be used to process insurance. Please make sure that all information provided is truthful and accurate.

2.At the time of registration, you must submit the completed registration form, personal statement, a U.S. check in the amount of $1,000 as deposit or the copy of the receipt, parental consent form, copy of the passport, copy of the identification card, English certificate (if any), resume (if any), and two 2”x 2” passport pictures (one attached on the registration form, the other to be used for name card.)

3.You must notify the Organizers in writing if your child (ren) need special medical care, living, or dining accommodations.

報名諮詢 「世界日報台灣辦事處」 電話：(02)8692-5588轉2751 李小姐 手機： 0935-080209 Email: rebecca.lee@chinesenews.com 傳真： (02)8643-3526 地址：台北縣汐止市大同路一段369號

「世界日報舊金山社教育活動組」 電話：650-259-2010 張小姐 Email: maggie.zhang@Chinesenews.com 傳真：650-692-8665 地址：231 Adrian Road, Millbrae, CA 9403

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