-
8/11/2019 13th ITCC2015 Application Form_2
1/3
"#$% & '( )
(ABSOLUTELY THAI) Kansadaeng Watthanatham Co., Ltd.
5/10 Soi Bangwak 64, Pasicharoen, Bangkok 10160 THAILAND
Tel.:+66850886848
Email:[email protected]
Facebook: AbsolutelyThai.org
Registration No.:0105554118312
OFFICIAL REGISTRATION FORM
The 13thInternational Thai Culture Camp
CU ASEAN Traditional Performing Arts, 5th - 8thFebruary 2015
ASEAN Festivals, 9th- 11thFebruary 2015*Participation Fee: USD
270.00
*Closing Date: 30thNovember 2014
Part 1: Participant's Particulars*** Please complete the form in
capital letters. All fields are mandatory, unless indicated
otherwise.***
1. Applicant Name (as appears on the passport):
(Mr./Mrs./Ms.)
Please provide a
Passport Size PhotoHere
2. Date of Birth: 3. Age:
4. Gender:
Male / Female
5. Nationality:
6. Passport No.: 7. Place of Issue:
8. Date of Issue: 9. Date of Expiry: 10. Contact Number:
11. Postal Address/Permanent Address:
12. Social Media (eg. Whatsapp, Facebook, LINE &
etc.):
13. Marital Status:
-
8/11/2019 13th ITCC2015 Application Form_2
2/3
"#$% * '( )
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 anyresponsibilities in
the event where the applicant did not state or mention any medical
conditions or allergies.
Part 2: Educational Background1. 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 Contactsa) Name: b) Contact Number:
c) Relationship: d) E-mail:
e) Mailing Address:
-
8/11/2019 13th ITCC2015 Application Form_2
3/3
"#$% ) '( )
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 15th
January 2015 by cash or bank transfer only. Receipt of payment
willbe 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 13th 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:
