15th Asian Congress of Surgery

15th Asian Congress of Surgery
held in conjuction with the
30th Annual Meeting of The Royal College of Surgeons of Thailand

Deadline for on-line registration : May 31, 2005

Congress Secretariat:
15th Asian Congress of Surgery
Royal College of Surgeons of Thailand
Royal Golden Jubilee Building
2 Soi Soonvijai , New Phetburi Road.
Bangkok 10320 Thailand.

Tel: 66-2716-6141/3
Fax: 66-2716-6144
E-mail :mailto:info@asacongress2005.org; rachit_h@surgeons.or.th

CONGRESS REGISTRATION FORM

Personal Details

Title :		Prof.		Asc.Prof.		Asst.Prof.		Dr.		Mr.
		Ms.		Mrs.		Miss		Others

*Last name :

*First name :

M.I.:

Organization/ Institution :

*Address :

*City :

*State :

*Postal code :

*Country :

Business phone

Fax

*E-mail :

* Country and city codes are required. Please include an extension number if there is any.
Special requirements :

Vegetarian

Muslim

Other requirement

Accompanying person information

Name (Mr/Ms/Mrs)

Registration Fees

Registration fees for PRECONGRESS ( 20 July 2005 )

select	Society	Place		REGISTRATION FEE (US$)
	Neurosurgery	Rajvithi Hospital*		20$
	HPB/LEST	Cholburi Hospital**		20$
	Colorectal surgery	Blue Sapphire Room***		20$
	Breast	Jade Room***		20$
	AUSA	Emerald Room***		20$
			Total (sub1)	US$

* Rajvithee Hospital , Bangkok
** Cholburi Hospital, Cholburi
*** Ambassador City, Jomthien, Pattaya

Registration fees for MAIN CONGRESS ( 21-23 July 2005 )

REGISTRATION PERIODS		Before May 31, 2005.	After May 31,2005	On-site Registration
Attendees		REGISTRATION FEE (US$)
	member	350 $	400 $	450 $
	non-member	400 $	450 $	500 $
	accompanying person	100 $	100 $	100 $

Summary of registration for payment: Attendee				US$
Accompanying Person(s)				US$
			Total (sub2)	US$

Registration Fee for participants includes

-Badge
-Admission to all scientific program sessions and exhibition
-Admission to all industry-sponsored luncheon and symposia
-Congress bag, program book, and abstract book
-Certificate of Attendance
-Invitation to opening ceremony,welcome reception and Banquet
-Coffee / tea breaks

Registration Fee for Accompanying person includes

The following will be provided for registered accompanying person
-Coffee / tea breaks
-Admission to the exhibition
-Badge
-Invitation to opening ceremony,welcome reception and Banquet
-Complimentory Half-day Tour.

Accommodation Registration

Room (Ocean Wing)	Room Rate(US$) Single/Twin
Deluxe Room	US$ 50
Superior Suite 1 Bed Room	US$ 100
Superior Suite 2 Bed Room	US$ 150
Superior Suite 3 Bed Room	US$ 225

In case of of any change or problem regarding HOTEL ACCOMODATION please
contact directly to:

Khun Napatwan Homharn
email: sales@ambassadorcityjomtien.com
Fax: 662-266-6440
Tel: 662-266-6449 upto 52.

Please mark your first,second and third choice of room.
Room of second choice :	*
Room of third choice :	*

Date of Arrival:	/ /2005	Date of Departure:	/ /2005
	(dd / mm / yy)		(dd / mm / yy)

To guarantee your accommodation reservation, an average of one-night deposit must accompany your registration.

Should the first choice of your preferred room be unavailable at the time your registration is
received, you will be assigned an available room according to the selection above.
The room rate will change accordingly.

Total (sub3) USD

Mode Of Payment

		Bank Transfer Account name : ASA/RCST2005 Account number. : 016-2-97700-4 Bank : Siam Commercial Bank Public Co. Ltd.Siriraj Branch , Bangkok 10700. SWIFTCODE : SICOTHBK
		Credit Card

Total (sub1)	US$
Total (sub2)	US$

Total (sub3)

US$

Total Amount Enclosed :

US$

Cancellation Policy
Registration cancellation
* Cancellations made before 30th. June 2005--Half of the registration fee will be refunded
** After 30th. June 2005, the registration fee is non-refundable.
Hotel accomodation cancellation
*cancellation made before 20th. June 2005--Half of the registration fee will be refunded
**After 20th. June 2005, hotel registration fee is non-refundable.