The 29th Annual Meeting of the Royal College of Orthopaedic Surgeons of Thailand

In Collaboration with Bone and Joint Decade and Asian Federation of Sports Medicine

Royal Cliff Beach Resort, Pattaya, Thailand on October 19-22, 2007

REGISTRATION FORM

Please complete this form with payment not later than August 31st, 2007 to the secretariat (online registration only)

Title o Prof. o Dr. o Mr. o Ms.

First Name...... Middle Name...... Last Name…….…………………….…
Institution/Organization………………………………………………………………………………………...... ……
Postal Address……………………………………………………………………………………………………...... ……
……………………………………………………………………………………………………………Country……………………………
Phone…….…...... …………………………..Fax…………………………………….E-mail………………...... ………..…….…
Accompanying Person(s)
1. Mr. Ms. First Name...... Last Name…………………………………………..
2. Mr. Ms. First Name...... Last Name……………………………………….….
REGISTRATION FEE / Before August 31st, 2007 / After August 31st, 2007
Participant / 350 US$ / 400 US$
Accompanying Person / 100 US$ / 100 US$

Total Registration Fee ……………………… US$

HOTEL RESERVATIONS

Rates inclusive of breakfast for 2 persons, taxes and service charges

(Rates available from October 18 - 22, 2007) One night deposit is needed

Check in date Check out date

Royal Cliff Beach Resort (Congress Hotel)

Mini-suite Room Single/ Twin US$ 100/room/night ………………………… …………………………

Club sea view Room Single/ Twin US$ 150/room/night ………………………… …………………………

Asia Pattaya Beach Hotel

Single Room (Sea View) Single US$ 61/room/night ………………………… …………………………

Twin Room (Sea View) Twin US$ 67/room/night ………………………… …………………………

Adriatic Palace Hotel

Superior Room Single/ Twin US$ 55/room/night ………………………… …………………………

Deluxe Room Single/ Twin US$ 82/room/night ………………………… …………………………

One Night Deposit ……………………… US$

TOTAL DUE: Registration Fee …..….US$ + One Night Deposit .….….US$ = …..…….US$

Types of payment

Bank transferred to "The Royal College of Orthopaedic Surgeons of Thailand (RCOST 2007)"

Account Number: 051-2-52825-1 Bank: SIAM COMMERCIAL BANK Branch: Rajavithi Hospital

Address: Rajavithi Hospital, Rajavithi Rd., Rajthevee, Bangkok 10400, Thailand

Swift Code: SICOTHBK

Please send us the pay-in slip to confirm your payment to fax no. 662-716-5440.

Credit Card Master Card VISA

Cardholder Name : ……..………………………………………………………………………………………………………

Card No.

Valid Through : ……………… / ……………… (month/year)

The last three digit number appearing on the signature panel

Cancellation and Refund; Cancellation should be made in writing or fax to the secretariat. The amount of refund will depend on the date of cancellation, as follow:

·  Cancellation received by September 15, 2007; 50% of the registration fee will be refunded.

·  Cancellation received after September 15, 2007: NO REFUND

·  All refund will be made after the congress.

Signature ………………………………………………………………
………./………………………/2007

Secretariat office:

The Royal College of Orthopaedic Surgeons of Thailand

4th Floor The Royal Golden Jubilee Building, 2 Soi Soonvijai, New Petchaburi Road, Huaykwang, Bangkok 10320, Thailand
Tel. (662) 716-5436 Fax : (662) 716-5440

E-mail : Website: www.rcost.or.th/meeting2007