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					                                   Cancellation Form
Cancellation
    In the event of Cancellation, please notify your intention to the Organizing Committee of the 2009 International
    Symposium on Mine Reclamation by Email or Fax, and then send the completed Registration Cancellation Form.
    For further information and inquiries about the 2011 International Symposium on Mine Reclamation,
    please contact: Fax: +82-(2)-569-5134 / E-mail: ksge@ksge.or.kr /
    Web : http://www.minereclamation.or.kr

1. Personal Information (It has to match with your registration information.)

    Mr.                  Ms.                         Dr.                      Prof.                    Mrs.
First Name :                                               Surname :
Correspondence Address :

Tel :                                                      FAX :
Email Address :

2. Accompanying Spouse / Companion Information(Fill out if you have accompanying person)

    Mr.                    Ms.                       Dr.                      Prof.                    Mrs.
First Name :                                               Surname :

3. Reimbursement Fee Calculation

Participant (Yourself)             USD/KRW
Accompanying Person                USD/KRW
Accommodation                      USD/KRW
Total Amount Paid                  USD/KRW

4. Bank Information for reimbursement

Bank Name
Branch Name
Swift Code
Account Number
Account Holder’s Name

				
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posted:10/11/2011
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