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PRE-REGISTRATION FORM The 7th “Collaboration
and Creativity in English Language Teaching and Learning in August
7-9, 2009 The Imperial Queen’s Park Hotel, Bangkok, Thailand |
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Please complete
this form in English BLOCK CAPITALS.
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First
Name |
Family
Name |
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Mr./Mrs./Ms. |
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Affiliation |
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Mailing Address |
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Telephone:
Office (......) (.......)
.................... Home
(......) (......).......................…. |
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(country code) (area code)
(country code) (area code) |
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Fax: Office
(.......) (.......)
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Home (......) (......).......................…. |
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(country code) (area code) (country
code) (area code)
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E-Mail:
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o 1. I
would like to join the conference as a presenter
Baht
3,000
(US
$ 100)
o 2. I
would like to use the LCD in my presentation
Baht
1,000 (US$ 40)
o 3. I would like
to join the conference as
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o
member (Asia TEFL o or Thai TESOL
member o Membership number _______________) |
Baht
3,000
(US
$ 100) |
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o non-member |
Baht 3,300
(US $ 120) |
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o
student |
Baht 2,700
(US
$ 85) |
o 4. I
would like to join as an attendee and pay per one day Baht
1,300 (US$ 35)
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Total
amount of payment (please complete)
Baht ___________ (U$ __________
)
All payments are
non-refundable. Overseas
participants must pay in
Methods of payment
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o by
bank draft/cashier’s check payable to “Thailand TESOL” (Personal
checks will not be accepted.) |
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o by
bank transfer to “Thailand TESOL” Savings Account No. 045-2-53721-3 The Siam
Commercial Bank Public Company Limited, Sapha Kachat Thai Branch. |
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o by
postal order/money order payable to Miss Srichan Tantineeranat, Chulalongkorn
Post Office Phatumwan, Bangkok 10330, Thailand (For participants in |
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o by credit card |
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o VISA
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o MasterCard |
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Credit
Card No. |
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Expiry date Signature of Cardholder
Pre-registration
is valid ONLY upon payment received by
Late
or on-site registration fee is Baht 4,100 (US $ 130) Cash Only
Pre-registration
form together with payment must be sent to:
Tel: 02-218-6100, 806-322-5360 Fax: (66)
02-218-6027 E-mail: srichan_t@hotmail.com
After sending registration form, please check your
name at our website: www.thaitesol.org
c/o
Chulalongkorn University Language Institute
Copies
of this form are acceptable