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(ABSOLUTELY THAI) Kansadaeng Watthanatham Co., Ltd.

5/10 Soi Bangwak 64, Pasicharoen, Bangkok 10160 THAILAND
Tel.: +66850886848
Email: phutsorn@gmail.com
Facebook: AbsolutelyThai.org
Registration No.: 0105554118312

OFFICIAL REGISTRATION FORM

The 13
th
International Thai Culture Camp
CU ASEAN Traditional Performing Arts, 5
th
- 8
th
February 2015

ASEAN Festivals, 9
th
- 11
th
February 2015
*Participation Fee: USD 270.00
*Closing Date: 30
th
November 2014


Part 1: Participant's Particulars
*** Please complete the form in capital letters. All fields are mandatory, unless indicated otherwise.***
1. Applicant Name (as appears on the passport):
(Mr./Mrs./Ms.)



Please provide a
Passport Size Photo
Here
2. Date of Birth:


3. Age:
4. Gender:
Male / Female

5. Nationality:
6. Passport No.:


7. Place of Issue:
8. Date of Issue: 9. Date of Expiry:


10. Contact Number:


11. Postal Address/Permanent Address:




12. Social Media (eg. Whatsapp, Facebook, LINE &
etc.):



13. Marital Status:


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14. E-mail Address:

15. Medical Conditions (if any)**:

16. Allegies (if any)**:

** Please indicate any health conditions or Allergies in the space above. The organizers will not hold any
responsibilities in the event where the applicant did not state or mention any medical conditions or allergies.


Part 2: Educational Background
1. Current Institute
a) University:


b) Country:

c) Field of Study (Degree):



Major: Year: GPAX:

_____ / _____

2. Languages Skills ( Excellent, Very Good, Good, Fair, Poor)
Foreign Language Listening Reading Speaking Writing
i. English



ii.


iii.



Part 3: Emergency Contacts
a) Name:


b) Contact Number:
c) Relationship:


d) E-mail:
e) Mailing Address:











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Part 4: Fee Payment (USD270.00) Terms and Condition

The organizer will not refund any amount paid in the event of any cancellation
from the participants after the payment is made. Full payment should be made
before 15
th
January 2015 by cash or bank transfer only. Receipt of payment will
be emailed after the payment is done.



Part 5: Confirmation of Participation / Mode of Payment

By filling this portion of the registration form, you are acknowledging that you:

1) are participating in the 13
th
International Thai Culture Camp: CU
ASEAN Traditional Performing Arts and ASEAN Festivals.
2) agree with the schedules and facilities provided.
3) have read and understood the above Payment Terms and Conditions
(Part 4) and the information provided in the above portion (Part 1,2 & 3)
are true and correct.


Mode of Payment:
(Please choose one)
CASH BANK TRANSFER

Signature of Participant:


Date:
Official Use Only:


Date: