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Document Sample
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PERSONAL INFORMATION
Title: ⃝Mr. ⃝Mrs. ⃝Ms. ⃝Prof. ⃝Assoc. Prof. ⃝Asst.Prof. ⃝ Dr. ⃝Others…………………………………..................
First Name..………………………………..……………Last Name………………….…………………………Country……………………………..................................................
Organization…………………………………………………………………………………………………………………………………………………………………………………………………….
Address……………………………………………………………………………………………………...........................................................................................................
Tel: ………………………….……………………………………..Fax:..…………………………………………………..Email:…………………………………………………………………………
Name on Badge (English): . . (First letter of first name . last name at maximum of 11 letters)
RECEIPT INFORMATION
Same as above ⃝ Yes ⃝ No (Please fill the information below)
Name..………………………………………………………………………………………………………………………………..…………………............................................................
Address…………………………………………………………………..………………………………………….................................................................................................
Tel: ………………………….……………………………………………………….………………Fax:.………………………………………………………………………….…………………………..
REGISTRATION FEE
Registration Fees Early Bird Rate Standard Rate
Package Included
(THB) Until 29 Feb 2012 Until 10 May 2012
- 3-day Congress including lunch and refreshments
- Abstract book & Proceeding CD
คนไทย ⃝ ๑๕,๐๐๐ ⃝ ๑๖,๕๐๐ - Welcome Reception
- 1 Technical Visit out of 4 options
- 3-day Congress including lunch and
น ักเรียน ** ⃝ ๑๐,๐๐๐ refreshments
- Abstract Book and Proceeding CD
- Welcome Reception
- 1 Technical Visit out of 4 options
- Welcome Reception
Accompanying Person ⃝ ๘,๐๐๐ - 2 Tour Programmes
- Technical Programme
Open Session on - Materials for 22 May 2012
Tuesday, 22 May 2012
⃝ ๑๒,๐๐๐
- Lunch
- At Dusit Thani Hotel
Congress Banquet, - Seat Reservation Fee is compulsory
Wednesday 23 May 2012
⃝ ๑,๐๐๐
- Limited to 600 seats, as first come, first serve
**Remark: Please attach your student identity documents.
Accompanying Person Details :
First Name..…………………………..…………………Last Name…………………………..………………………….………………Country……………………………..............................
Name on Badge of Accompanying person (English): . . (First letter of first name . last name at maximum of 11 letters)
⃝ Accompanying Person Tour (You can either choose one or both tour programmes)
⃝ Bangkok Orientation Tour (May 22, 2011)
⃝ A UNESCO World Heritage Site (May 23, 2011)
⃝ Will Not Attend
Congress Secretariat: ProCOngress (Thailand) Co., Ltd.
4/383 Moo 6, Soi Nakniwas 37 Road, Ladprao, Bangkok 10230 Thailand
Tel:+66 2 965 1580 Fax: +66 2 932 4454
Website : www.wtc2012.com Email : registration@wtc2012.com
SOCIAL FUNCTIONS (Please indicate if you will attend any of the following optional conference events. No additional charge)
⃝ Welcome Reception
⃝ Opening Ceremony
⃝ Closing Ceremony
ADDITIONAL INFORMATION
⃝ Technical Visit
(choose 1 from 4 options) ⃝ Deep Excavation Project in Bangkok
⃝ Bangkok Water Tunnel Rehabilitation Project
⃝ Bangkok Storm Drain Tunnel at Bang Sue
⃝ Will Not Attend
⃝ Dietary Requirement ⃝ Normal ⃝ Vegetarian
PAYMENT METHOD
Total Amount of Payment
THB USD
Bank Transfer
Note : All bank charges are to be paid by registrants.
Bank Name: Siam commercial Bank Plc. Branch: Thai Red Cross Society Swift Code: SICOTHBK
Bank Address: 1873 Rama 4 Road, Pathumwan, Bangkok 10330
Beneficiary: EIT-WTC 2012-Registration Account Number: 045-550007-9
Your money transfer reference number: ______________________________________
Credit Card Payment
Note : The submitted information will be kept confidential. And credit card payment charge is 3.32%.
⃝ VISA ⃝ MASTERCARD
Credit Card Number _________________________________________ Expiry Date _______________________________
Name of the Card Holder_____________________________________ Last 3 Digits on the signature bar______________
Signature: _________________________________________________ Date ____________________________________
Please Fax or Email the registration form with the copy of payment to:
ProCOngress (Thailand) Co., Ltd.
4/383 Moo 6, Soi Nakniwas 37 Road, Ladprao, Bangkok 10230
Tel: +66 2 956 1580 Fax: +66 2 932 4454
Website: http://www.wtc2012.com Email: registration@wtc2012.com
TERM & CONDITION
This registration will be accepted only upon received of full payment.
Registered delegates who unable to attend will received 50% refund, provided that a written request is received by WTC
2012 Secretariat before 30 April 2012.
All approved refunds will be processed and issued 60 days after the congress.
Transfer to another name is accepted in a written request before 30 April 2012.
Signature______________________________________________Date____________________________
Congress Secretariat: ProCOngress (Thailand) Co., Ltd.
4/383 Moo 6, Soi Nakniwas 37 Road, Ladprao, Bangkok 10230 Thailand
Tel:+66 2 965 1580 Fax: +66 2 932 4454
Website : www.wtc2012.com Email : registration@wtc2012.com
