"Registration Form"
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Symposium on Mineral,
Rock, Energy, and Water Resources of Thailand: Towards the Year 2000 October
28 -29, 1999. Chulalongkorn Univ., Bangkok, Thailand.
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Please fill
in the registration form for participation to the symposium using BLOCK
CAPITALS or a
TYPEWRITER. (Please return with payment before October
15, 1999)
Name : Dr., Mr., Ms.
.
..
.
family name
given name
Mailing
Address:
..
..
Country
.
Phone
Fax
..
.
E-mail
.
Registration
I would like to
[ ] Attend the symposium only.
[ ] Attend the symposium and
present the paper.
Title
.
..
Registration
Fee
Participant
[ ] 900 Bht
Student
[ ] 250 Bht
(Meals, Refreshments, Receptions,
Proceedings, and VAT included)
Method
of Payment
[ ] Visa [ ] Master
Card [ ] Bank Transfer
[ ] Cash on site
Name Holder:
.
Date:
.
Card Number:
.
..
.Expiration
Date:
.
..
Signature:
.
.Date:
.
.
..
Bank
Transfer to the following account:
Account name:
Geology
forty
.
Account No:
...
162-1-04085-2
..
Bank Name:...... KRUNG
THAI BANK PUBLIC COMPANY LIMITED (SAMYAN OFFICE)
.................
Hotel
Reservation
Please reserve a room for
me at the SASA International House, Chulalongkorn University
Type of Room
Single
Twins
..
..
..
Check- in Date
..
Check-out Date
.
Please
duplicate the form and distribute to other interested persons.
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