PARTICIPANT REGISTRATION FORM


THE 3rd ANNUAL CHILD HEALTH CARE CONFERENCE OF ANGKOR HOSPITAL FOR CHILDREN
Topic: Pediatric Tropical Diseases
Date: 26th October 2019 (7:00am-17:00pm)
Venue: Sokha Siem Reap Resort and Conference Center, Siem Reap, Cambodia

PERSONAL DETAILS:

*Required field
Ex: 012568923

Registration Fee

Fee: USD $100 (for foreigners)

Fee: USD $30 (for Cambodians)

Payment for registration shall be made in full prior to the registration deadline.
The payment can be made in cash to “Angkor Hospital for Children” or transferred Bank Transfer, ABA Bank Wing Transfer
Payment made for the conference is non-refundable.
ការបង់ប្រាក់តាមរយៈលេខកូដ វីង ខាងលើ មិនគិតថ្លៃសេវាឡើយ។
Payment via above Wing Codes is free of charge.
Payment made for the conference is non-refundable.
Payment made for the conference is non-refundable.

Please enclose this form with the following documents, and submit to Angkor Hospital for Children no later than 06 October 2018:
  • Soft copy of participation registration form (send to e-mail: [email protected])
  • Receipt of payment or bank slip