12th Bangkok International Symposium on HIV Medicine

January 14-16, 2009 Queen Sirikit National Convention Centre Rachadapisek Road, Bangkok

* Registration Form

Registration Form ( Download PDF File )

* Registration Online

Registration Fees
	Before 31st Dec 2008	After 31st Dec 2008
MD and General	THB 7,500 US$260	THB 10,000 US$350
Student	THB 3,500 US$130	THB 5,000 US$180
* Person registering as a student must enclose a copy of student card or a document reference from the school

CONTACT INFORMATION
Title:	Dr. Mr. Ms.
*Firstname:**		*Lastname:**
Institution:
Address:
*Phone:**		Fax:
*Email:**
Certificate of attendance required?		YES No

REGISTRATION INFORMATION
*Registration Fees:** *Person registering as a student must enclose a copy of their student card or a document from the school.


BILLING INFORMATION
*Cardholder Firstname:**		*Cardholder Lastname:**
*Address:**
*City:**		*Province:**	("N/A" if not related)
*Zip:**		*Country:**
*Email:**