REGISTRATION FORM
 
 
14th World Fertilizer Congress
Chiang Mai, Thailand, January 22-27, 2006
 
 
 
 
1. 
 Title : Prof. Dr. Mr. Ms. Other    Sex : male female  
 
First Name : * Last Name : *  
 
 
2. 
 Organization :  
 
 
3. 
 Postal Address :  
 
 
City : Zipcode : Country : *  
 
    Tel : Fax : E-mail : *  
 
 
4. 
 I expect to present a paper : Yes No  
    Type of presentation preferred : Oral Poster (Title of the paper : )  
 
 
5. 
 Spouse registration Yes (Name ) No  
 
 
6. 
 Registration Fees (Check the appropriate box)  
 
   
Registration Fees
before 31st October 2005
after 31st October 2005
Amount Due
Congress Participant
$US350
$US400
Spouse
$US150
$US180
 
 
    CANCELLATION : the deposit will be refunded (less 50% for administration charge) only upon written cancellation addressed to The Secretariat, 14th WFC (letter or fax) before 30 November 2005. No refunds will be made after 30 November 2005.  
 
 
7.
 Registration for Congress Tours  
 
   
Congress Tour
Date tour
Tour fees
(Number person)
Total tour fees (US$)
Pre-Congress Tour
(BKK - CM)
20 - 22 Jan
(3 days)
300 US$
Mid-Congress Tour
(CM)
25 Jan
(1 days)
Route 1

 
Route 2
Route 3
Route 4
Post-Congress Tour
(CM - BKK)
28 - 31 Jan
(4 days)
400 US$
 
 
    Remark : At least 20 persons for Pre-Congress Toue and Post-Congress Tour.
The fee for Mid-Congress Tour is included in the Registration Congress fees.		  
       
 
 
 
8.
 Reservation for Accommodation  
       
   
Room Type
Rate (US$/night)
Date in
Date out
Total amount (US$)
Single room
60
Double room
80
Junior room
110
 
       
    Remark : Rooms will be allocated on a first come, first serve basis. All participants will pay the balance of the bill directly to the hotel on departure or on site registration.  
       
 
 
 
9.
 Payment : Registration fees and tour fees total (US$)  
       
    Bank Transfers must be made to : Bangkok Bank PCL, Bangkhen Branch, 2124 Phaholyothin Rd., Chatuchak, Bangkok 10900, THAILAND.  
    For the Account of : The 14th World Fertilizer Congress      Account Number : 161-5-49330-9
Swift Code : BKKBTHBK		  
       
    Credit card : VISA MASTER  
    I, the undersigned authorize The 14th World Fertilizer Congress to withdraw from my account the amount of (US$)  
    CARD No. (16 digits without spaces or dashes)
Date of Expiration Day /Month /Year 		 
    Card Holder Name  
       
    Remark : An acknowledgement of payment will be sent to the participant within a maximum of 60 days after receipt of payment. The original receipt of payment will be given to the participant after on-site registration counter.  
       
 
 
 
 
10.
 Registration Code (Please fill up your own code, and remember to access your data next time.)  
   
Enter Registration Code *
Confirm Registration Code Again *
 
       
       
   
Date 6/9/2553 17:28:54 Signature .................................................................
  
       
       
 
 
                    Recommendations :
                     - Registration can be conducted via our website at : www.ldd.go.th/wfc14th.
                     - Instruction and information for this congress indicated on the website.
                     - The congress organizer strongly encourages participants to register online.