(IWAC2010)The First International Congress on Women 's Health and Unsafe Abortion January 20-23, 2010 Imperial Queen's Park Hotel Bangkok, Thailand.

Registration

First Name ::	*
Middle Name ::
Family Name ::	*
Title( for Mailing Address)::	Prof. Dr. Mr. Ms.
Institute / Organization ::
Mailing Address ::	Home Office
Address ::	*
Country ::	*
Telephone (include international code) :
Fax (include international code) :
E-mail :	*

Profile : (select all that apply)

Obstetrician/Gynecologist
General Practitioner
Nurse
Researcher / Scientist
Resident/Student
Social Worker
Others: (please state)

Registration Fees for Participants

Registration Fee	Regular Registration
Registration Fee	Early registration (before Sep 30, 09)	Late registration (Oct 16 - Dec 31, 09)	On-site registration (Dec 1, 09 - Onsite)
Physician	USD350	USD500	USD550
Non-physician	USD350	USD400	USD450
Accompanying Person	USD300

*main congress must registered and seat limited at 40 persons (first- come- first- serve basis)*

Summary of registration for payment: Attendee USD:
Accompanying Person(s) USD:
Total amount USD:

Mode of Payment:

Credit Card

Bank Transfer -Registration fee can be paid by credit card. The bank transfer or wire transfer would be offered for group registration only. Bank draft or transfer must be payable to the account below.

Account name : IWAC 2010 - Registration
Account number : 026-4-35767-1
Bank : The Siam Commercial Bank PLC. (Ramathibodi Branch)
Swift Code : SICOTHBKBank Address : 270 Rama 6 Road, Phyathai, Rajthevi, Bangkok 10400, Thailand

supported by:

Organized by:

Endorsed by: