Transcript Slide 1

International Senior Project Conference in
Engineering and Technology
Bangkok, Thailand
27-29 March 2014
CONFERENCE REGISTRATION FORM
1
Print or Type
Name
Last Name
Prof./Dr./Mr./Ms./Mrs.
Middle Name
First Name
Department
Institute/University
E-mail:
Mailing
Address
Street/PO Box
City
Province/State
Country
Business Telephone:
Postal/Zip
Business Fax:
I have special needs (please check all that apply and attach description):
access
audio
visual
vegetarian
kosher
other
OPTIONAL: Please indicate your Emergency contact name & telephone number
Emergency Contact:
Emergency Telephone:
I am registering as: (check all that apply)
Technical Paper Presenter
Poster Session Presenter
Conference Attendee
Other
2 REGISTRATION FEES
The registration fee will be fully waived for only the main presenter of a technical paper or poster. The registration fee is collected solely
to cover costs for accommodation, food, and an optional tour (on March 29). Please check the appropriate option below:
2-Night Stay
2-Night Stay
Without Tour
With Tour
(March 27-28)
(March 27-28)
R01 Presenter with KMUTT support**
R02 Presenter without KMUTT support/Attendee**
R03 Presenter without KMUTT support/Attendee (Single room)
WAIVED
2300 THB/HEAD
3600 THB/HEAD
WAIVED
2800 THB/HEAD
4100 THB/HEAD
** Applicable for twin sharing only.
PAYMENT METHOD
We accept only cash in Thai Baht (THB) for the registration fee. You can make the payment to our staff at the conference registration
desk on March 27, 2014. We apologize for any inconvenience regarding this restriction for the payment form.
Please return this form with all requested information to Miss Phattaree S.
((preferably) E-mail: [email protected] and [email protected] Fax: +66-2427-8787)