international pediatric emergency and critical care conference_eng
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8/2/2019 International Pediatric Emergency and Critical Care Conference_ENG
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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
120 US Dollar 140 US Dollar
Course 2:Workshop forPediatric Emergency andCritical Care BedsideUltrasoundDetails
220 US Dollar 240 US Dollar
Method of Payment Bank Transfer PaypalDate 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 paidIs this include hotel reservation from page 2 YES NO
* Please scan your payment method and send to [email protected]
Signature of Applicant:
mailto:[email protected]:[email protected]:[email protected] -
8/2/2019 International Pediatric Emergency and Critical Care Conference_ENG
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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 dateto 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/