"Geriatric Psychiatry" training : Registration form

    
Name :
Institute/Hospital :
Mailing address :
Tel./Fax : Tel. Fax
E-mail address :
Registration fee :

 
     Before 21th Apr '99        Since 21th Apr '99
Doctor/Psychiatrist
and Allied mental health		        1,500 Baht                 1,800 Baht

Resident/Student       1,000 Bahtt                  1,200 Baht
Accompanying
persons :

 

 Registration for accompanying person : person X 500 Baht
Name of accompanying persons
1.
2.
      (Include one day tour and reception dinner)
Post-training tour

 Registration of post-training tour (7-9 May '99)
for person X 2,500 Baht
Transportation : Thai International domestic flight
To Hat-Yai ... TG :   Arrival Date      Time
From Hat-Yai TG :  Departure Date Time
Accommodation :
J.B. Hotel reservation Check In date Check Out date
Single room (800/room with breakfast)
Double room (950/room with breakfast)

     If you have any any question or comment please fill messages below
       

       Click for sending this form       or Click to cancel.

*** We will confirm your registration soon ***
Thank you
Sorayut Vasiknanonte, M.D.
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