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)
Name (Mr/Ms/Mrs)
Name (Mr/Ms/Mrs)
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.




 
For more information please contact web site: http://www.asacongress2005.org/. email: info@asacongress2005.org
© Copyright 15th Asian Congress of Surgery. All rights Reserved 1999-2004