Registration Information

❖ Personal Details

Name in English

Title * :

First name * :

Middle name:

Last name * :

Department:

Institution:

❖ Contact Details

Address:

City/District:

State/Province:

Postal code:

Country * :

Telephone No.:

Fax No.:

Mobile phone no.:

E-mail * :

❖ Registration Type

Type	Fee Onsite rate (USD)
Main Congress
Plastic Surgeons	350.00
Residents *	200.00

Total 0.00 USD

Remark: * All Residents are required to provide a Letter of Verification

Attach document : (*.jpg, *jpeg, *.png , *.pdf)

❖ Receipt Details

same as contact address

Name:

Address:

❚ Payment Option

By Online payment with credit card
By Bank Transfer: The Siam Commercial Bank PLC.
Account name: The Society of Plastic and Reconstructive Surgeons of Thailand
Account number: 043-250-6494
Name of Bank: The Siam Commercial Bank PLC.
Branch: Thanon Petchaburi Tat Mai Branch
Address: 2046 Phetchaburi Tat Mai Road, Bangkapi Sub District, Huai Khwang District, Bangkok 10310
Swift Code: SICOTHBK

* Please state your name, make sure that your remittance is free of all bank charge and attach a copy of your bank transfer via e‐mail: thaiplasticsurgeons@gmail.com

Please fill the required fields(*).