Registration form
Name Title *
First Name: *
Your answer
Last Name: *
Your answer
Name Extension:
Your answer
Name of Institution: *
Your answer
Address: *
Your answer
Primary E-mail Address: *
Your answer
Contact Number: *
Your answer
Type of Participation/Presentation *
Food Preference/Restrictions *
Allergic (specify):
Your answer
Registration Fees
The registration includes:
3 lunches
1 gala dinner
5 refreshments
book of abstracts
Pick-up Transportation (fill up form A)
Early bird registration :December 1st, 2017 - January 15th, 2018
Regular Registration : January 16th - 31st, 2018
Cultural Excursion (optional) 25 USD or 800 Baht *
Bank Information for Payment
Beneficiary’s Name : Boromarajonani College of Nursing Nakhon Lampang
268 Pakham Road, Huawieng, Muang District,
Lampang Province 52000 Thailand THAILAND
Bank Name/ Branch : Krungthai Bank, Thailand
Account No/IBAN : 536-0-91271-5
Office Code : 536
Beneficiary bank SWIFT code : KRTHTHBK
Bank country : THAILAND

*After filling up the registration form and transferring the money to the bank, scan the transaction receipt and send it to
*For more information about the call for abstract and guidelines for presentation please visit
*Fill up form A (transportation booking form) to book for the time of pick-up.
*Changes of the information above would not be recognized after settling the registration fee. Should you have further queries email us at

Pick-up Transportation (fill up form A)
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