September 25, 2017

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PARTICIPANT DETAILS

NAME (to appear on printed materials):
POSITION:
INSTITUTION:
ADDRESS:
CITY:
POST CODE:
COUNTRY:
PHONE:
MOBILE:
PHONE:
EMAIL:


EMERGENCY CONTACT (REQUIRED)
FULL NAME:
RELATIONSHIP:
PHONE:
EMAIL:


ADDITIONAL CONTACT (OPTIONAL)
FULL NAME:
POSITION:
PHONE:
EMAIL:
I will require a special diet (please specify):
Preexisting medical conditions (please specify):


REGISTRATION DETAILS

The registration fee of $1,600 includes 7 nights' accommodation in 4 star hotels or equivalent, an academic programme including seminars and visits to Chinese HEIs, a cultural programme, local transportation in China, an Englishspeaking
guide and meals.

Please note that the above fee is in US Dollars and does not include airfare, visa fees, travel insurance or other associated travel expenses. For travel insurance, participants are strongly recommended to apply prior to their departure.

Kindly transfer the registration fee to the following account:

ACCOUNT:
SEAMEO RIHED
ACCOUNT NUMBER:
003 2 90026 8
BANK NAME:
Thai Military Bank Public
ADDRESS:
TMB Bank, 34 Phayathai Road, Phayathai, Ratchatewi, Bangkok 10400 Thailand
BIC/SWIFT:
TMBKTHBK

Note that transfer fees and additional bank charges are to be borne by the participant. SEAMEO RIHED shall receive the full amount of the registration fee. Kindly make your payment and send a scanned copy of the bank transfer to SEAMEO RIHED by email rihed@rihed.seameo.org or fax +66 2644 5421 by 24 March 2017.


TRAVEL ITINERARY
Please complete the section below if you have already booked and confirmed your flights.

ARRIVAL

City/Airport
Arrival Date
Flight Number
Arrival Time



DEPARTURE

City/Airport
Arrival Date
Flight Number
Arrival Time



Your flight itinerary information may be provided after submission of this Form, but no later than 31 March 2017.







COMPLETED REGISTRATION FORMS

* Ms .................... | @rihed.seameo.org | +66 2644 985662 ext. 101
* Ms .................... | @rihed.seameo.org | +66 2644 985662 ext. 107


The deadline for registration is March 2017. Please note that registrations are based on a firstcome firstserved basis.


I have read and accepted all details and conditions pertaining to my participation in the 4th SEAMEO RIHEDACC Study Visit Programme to China.

Signature


Date :