Registration Form

Register Type
Title
First name Last name Medical License Number / Thailand Nursing and Midwifery Council Membership Number Sex
Institute Address Country Telephone Email Address Dietary Restrictions
Company Support Name (if any)

Billing Address

Name Address

Activities

 USD  Baht
 
  Lecture (October 25-26, 2019) (500 USD) 48 spots available
 
  Hands-On Workshop (October 26, 2019) (100 USD) 16 spots available
 
  Lecture (October 25-26, 2019) (6,000 Baht) 48 spots available
 
  Hands-On Workshop (October 26, 2019) (3,000 Baht) 16 spots available

Total Registration Amount

Hotel Reservation

 
Reserve

     Room type : Cape suite      5,000 BHT/night
     Room type : Cape suite      150 USD/night
     Room type : Junior suit      4,000 BHT/night
     Room type : Junior suit      125 USD/night
     Room type : Suite studio     2,000 BHT/night
     Room type : Suite studio     65 USD/night