Online Registration Form
A One Day Symposium on Food and Health Communications - International Perspectives
December 6, 2007, Bangkok, Thailand

Please note required fields are marked with *
A. Personal Information
Family Name *
First Name *
Title/ Professional *
Company/ Organization *
Faculty/ Department *
Street/ P.O.Box *
City *
State *	(Please enter "NA" if you are outside the USA)
Postal Code/ Zip Code *
Country *	------------ Please Select ------------AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosByelorussian SSRBelgiumBelizeBeninBermudaBhutanBoliviaBosnia HercegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Dem. Rep. OfCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicCzechoslovakiaDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreat BritainGreenlandGrenadaGuadeloupeGuamGuatemelaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic Republic OfKorea, Republic OfKuwaitKyrgyzstanLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Fed. States OfMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNeutral ZoneNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent & GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & IslandsSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province Of ChinaTajikistaTanzania, United Republic OfThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUSSRUzbekistanVanuatuVatican City StateVenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Futuna IslandsWestern SaharaYemen, Republic ofYugoslaviaZaireZambiaZimbabwe
E-mail *
Phone Number *	(+ country code, area code, number)
Fax Number *	(+ country code, area code, number)
Address for invoice receipt of payment *
B. Accompanying Person (s)
1. Full Name
2. Full Name
3. Full Name
C. Registration & Payment
USD 200 per person   Note:   The admission cost included keynotes, keynotes, coffee breaks, luncheons and conference materials. English is the official language for this event. Registration will only be accepted with full payment by wire transfer, check/draft or Paypal. The registration fee does not include accommodation or travel. Registration will only be accepted with full payment. Payments made on-site are subject to additional 5% surcharge. Terms & Condition   All fees must be paid in full upon booking. Asian Food Information Centre reserves the right to refuse entry if monies have not been received. Seating spaces are offered strictly on a first come first serve basis. Confirmation of your registration will be sent to you by email within 72 hours of receiving your registration. If you do not receive confirmation, please contact Asian Food Information Centre as soon as possible.   Cancellation Policy:   Notice of cancellations must be made in writing. Where written confirmation is received 31 days prior to the start of the event, delegates will receive a full refund less 25% administration costs. Where written confirmation is received between 30 and 14 days prior to the start of the event, the delegate will be entitled to a refund of 50%. There will be no refund for cancellations less than 14 days to the start of the event. Substitutions may be made at any time at no extra charge subject to requests being received in writing and approved by Asian Food Information Centre. Asian Food Information Centre reserves the right to cancel or change the content, timing and speakers of the program without notice. If the event is postponed or cancelled, Asian Food Information Centre does not accept liability for any costs or personal expenses such as travel or hotel charges incurred by the delegate.    Payment Method*   Cheque or Bank Draft Please registered mail with the registration form to Food & Nutrition Communications Co., Ltd. 149/27-28, 5A, 5th Floor, Pornpiwat Building, Soi Anglo Plaza, Suriwong Road, Suriwong, Bangrak, Bangkok 10500 Thailand Please quote your name, company name at the back of the cheque. Payable to: Asian Food Information Centre   Telegraphic Transfer Account name: Asian Food Information Centre Bank: DBS Bank, The Development Bank of Singapore Ltd. 6 Shenon Way, DBS Building, Singapore 068809 Account name: Asian Food Information Centre USD Account Number: 0074-000602-01-8-022 SWIFT DEST: DBSSSGSG   Paypal
Payment Method *	Cheque/Bank Draft Telegraphic Transfer PayPal
Draft No.