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Welcome to Thailand
" SAWASDEE KA"
   

 		  
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Online Registration  
I. Identification
  Title: * Dr. Mr. Mrs. Ms.
  First name: *
  Middle name: *
  Last name: *
  Institution: *
  Address: *  
 
  City: *
  State:      Zipcode: *
 
  Accompanying Person Information
 
Title
 Firstname
 Lastname
 
Title
 Firstname
 Lastname
 
II. Registration fee
Staus Until 15 Sep 2006 16 Sep 2006 - Onsite
Member USD 350 USD 400
Non-member USD 450 USD 500
Trainee USD 250 USD 300
One Day Nov,2006 USD 200 USD 250
Accompanying USD 120 USD 150
Total(II)USD
 
III. Payment
  Title: * Dr. Mr. Mrs. Ms.
  Firstname: *
  Lastname: *
  Address: *  
 
  E-mail: *
 
 
 


The President’s Office and Secretariat
Siriraj Cancer Center, ChalermPrakiat Building
Faculty of Medicine Siriraj Hospital  Mahidol University
2 Prannok Road  Bangkok 10700, Thailand
Fax :(662) 412- 9169   Website : http://www.afsumbthailand.org

 
  

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