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<div align="left">附件：企业并购重组上市发行与新三板挂牌转让及私募融资实务操作培训班报名表</div>
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<div align="center">单位名称</div>
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<td width="543" colspan="7">
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<td width="100">
<div align="center">详细地址</div>
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<td width="321" colspan="5">
<div> </div>
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<td width="85">
<div align="center">邮 编</div>
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<td width="137">
<div> </div>
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<td width="100">
<div align="center">联系人</div>
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<td width="113" colspan="2">
<div align="center"> </div>
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<td width="95">
<div>电 话</div>
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<td width="113" colspan="2">
<div align="center"> </div>
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<td width="85">
<div align="center">传 真</div>
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<td width="137">
<div align="center"> </div>
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<td width="100">
<div align="center">学员姓名</div>
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<td width="47">
<div align="center">性别</div>
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<td width="66">
<div align="center">职 务</div>
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<td width="95">
<div align="center">所在部门</div>
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<td width="113" colspan="2">
<div align="center">电 话</div>
<div align="center">（含区号）</div>
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<td width="85">
<div align="center">E-mail</div>
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<td width="137">
<div align="center">手 机</div>
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<div align="center"> </div>
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<td width="95">
<div align="center"> </div>
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<td width="137">
<div align="center"> </div>
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<div align="center"> </div>
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<td valign="top" width="47">
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<td width="66">
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<td width="95">
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<td width="137">
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<td width="66">
<div align="center"> </div>
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<td width="95">
<div align="center"> </div>
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<td width="113" colspan="2">
<div align="center"> </div>
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<td valign="top" width="85">
<div align="center"> </div>
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<td width="137">
<div align="center"> </div>
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<td width="100">
<div align="center"> </div>
</td>
<td valign="top" width="47">
<div align="center"> </div>
</td>
<td width="66">
<div align="center"> </div>
</td>
<td width="95">
<div align="center"> </div>
</td>
<td width="113" colspan="2">
<div align="center"> </div>
</td>
<td valign="top" width="85">
<div align="center"> </div>
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<td width="137">
<div align="center"> </div>
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<td width="100">
<div align="center"> </div>
</td>
<td valign="top" width="47">
<div align="center"> </div>
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<td width="66">
<div align="center"> </div>
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<td width="95">
<div align="center"> </div>
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<td width="113" colspan="2">
<div align="center"> </div>
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<td valign="top" width="85">
<div align="center"> </div>
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<td width="137">
<div align="center"> </div>
</td>
</tr>
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<td width="100">
<div align="center"> </div>
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<td valign="top" width="47">
<div align="center"> </div>
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<td width="66">
<div align="center"> </div>
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<td width="95">
<div align="center"> </div>
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<td width="113" colspan="2">
<div align="center"> </div>
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<td valign="top" width="85">
<div align="center"> </div>
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<td width="137">
<div align="center"> </div>
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<td width="100">
<div align="center">住宿安排</div>
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<td width="543" colspan="7">
<div> □ 标间 □ 单间</div>
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<tr>
<td width="409" colspan="5">
<div>联系人：李桐老师 </div>
<div>电 话：010-58443636 </div>
<div>传 真：010-59426123</div>
<div>邮 箱：fgwchina@vip.163.com</div>
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<td width="234" colspan="3">
<div> </div>
<div align="center">单 位 签 章</div>
<div align="right">二○一三年 月 日</div>
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<td width="643" colspan="8">
<div align="left">备注：1.请认真逐项填写此表；</div>
<div align="left"> 2.此表复印有效。</div>
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