PAYMENT FORM (Individual)

ASPAC CONFERENCE 2009

PAYMENT FORM (Individual)

Name ______

Institution______

Address______

______Country ______

Phone ______Fax ______

E-mail ______

Amount Early Registration (By January 31, 2009)
US $180 for ASPAC Members
US $280 for Non ASPAC Members

Normal Registration (After January 31, 2009)
US $220 for ASPAC Members
US $320 for Non ASPAC Members

Note:

- For payment by bank transfer, please pay to ASPAC account in full amount.

- For payment by credit card on-line, please add US$10.- to your total amount due,

to cover the Bank fee for each transaction.

Payment Method
By electronic funds transfers to:

Swift Code: AYUDTHBK

Bank: Bank of Ayudhya Public Company Limited Bank Code:25

Account Name: NSM-ASPAC Currency: USD

Account No. : 292-5-00001-9

Branch: Main Office, Bangkok Thailand
Address: 1222 Rama III Road, Bang Phongphang, Yannawa, Bangkok 10120

Thailand.

Tel. (662) 0-2296-4387, 0-2683-1000 Fax (662) 0-2683-1304

By Credit Card On-Line (Visa or MasterCard), please go to:

(see FOR CONFERENCE 2009), User name and password to log-in will be given upon request, please send E-mail directly to: or fax your request to: +66 2577 9990

Authorized Signature ______ Date ______

Remark: We do not accept cash or cheque.

Correspondent Banks

Remarks: The Account number and related documents will be cancelled, if the Bank has not received the initial deposit within 1 month.