8/2/2019 Pediatric Huahin Register Form_THA
1/2
1
International Pediatric Emergency and Critical Care
Conference17th-19th August 2012
Amari Huahin Thailand
Applicant Information
Name: Last Name:Current Workplace:
Town: County: Postal Code:Phone: E-mail: Fax:Position:
Registration Fee (Please check on the conference you would like
to attend.)
Course 1: International Pediatric Emergency and Critical Care
ConferenceDate 17
th-18
thAugust Noon
Course 2 :Workshop for Emergency and Critical Care Bedside
UltrasoundDate 18
thNoon -19
thAugust Noon
Registration Fee (Please check on the conference you would like
to attendEarly Bird(Before 15July)
Pre Registration
Course 1: InternationalPediatric Emergency andCritical Care
Conference
3,000 Thai Baht 3,500 Thai Baht
Course 2:Workshop forPediatric Emergency andCritical Care
BedsideUltrasoundDetails
5,500 Thai Baht 6,000 Thai Baht
500 Method of Payment Bank Transfer OthersDate of transfer
Payable to:Emergency Unit, Outpatient department King
Chulalongkorn Memorial HospitalAccount : 0455230014Bank: Siam
Commercial Bank Public Company Limited (SCB)Bank Address: 1873
Praram 4 Road Pathumwan, Pathumwan Bangkok 10330Swift Code:
SICOTHBK
Please state the amount of transfer that you paid
* Please scan your payment method and send to [email protected](
slip atm email ) 022565283 0891042164
Signature of Applicant:
mailto:[email protected]:[email protected]:[email protected]
8/2/2019 Pediatric Huahin Register Form_THA
2/2
2
International Pediatric Emergency and Critical Care
Conference17th-19th August 2012
Amari Huahin Thailand
Reserve Hotel
Yes I would like to reserve a room with a discount rate with
Amari Huahin
http://th.amari.com/huahin/
I would like to check in click to enter date to click to enter
date
Amari Huahinis a brand New Hotel that kindly provide our
conference group discountprice to promote the newly open beach
hotel.After the payment transfer, sale representation email back
for confirmation
Children, if
membershipprivilegesdesired
Room Rates (THB) per room per night inclusive of
dailybreakfast
Single Double Extra Bed
Adult Child Below 12Years
95 100 50 Free
Suites 200 200 50 Free
Signature of Applicant: Date:
http://th.amari.com/huahin/http://th.amari.com/huahin/http://th.amari.com/huahin/
