BH4-PKU 2009
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Conference Registration : Part 1 of 2 ( Personal Details / Payment)
1. Personal Details
Title* Prof. Dr. Mr. Mrs. Ms.
First name*
Middle Name/ Initial
Last Name *
Suffix (Jr., Sr., II, etc)
Academic Degree MD BSc MSc PhD Other
Department
Room Number / Mail stop / PO Box, etc
Institution / University *
Street *
City *
2a. U.S. Only
State *
Zip Code*
2b. Non-U.S. Only
Postal Code *
Province
Country * Leave blank if U.S.
3. Communications
Telephone *  U.S. use "(999) 999-"
Fax  U.S. use "(999) 999-"

Email*
You will be contacted via this email


Please type your valid email address carefully
4. Special Requirements
  Check here if you require special requirements to fully participate in the meeting.    
           
           Please describe briefly

          
5. VISA

Check here if you are required to have a VISA before entering Korea.    

 


A visa is required for citizens of countries that do not have visa-exempt agreements with Korea. Please contact the nearest Korean Embassy or Consulate for visa requirements. Other information available - click here

6. Registration *
  * Registration fees cover 2 official dinners (welcome reception and conference dinner), 5 lunches, 9 coffees, and conference materials.
Registration Fee & Meals *
Fee Before 31 March
Fee on or after 31 March
Active Participant US$ 300 US$ 350
Accompanying Person US$ 100 US$ 120
Trainee/ Student member ** US$ 100 US$ 120
  ** Trainee/Student Registrations
The Supervisor (department chair or advisor) below certifies that the above-named trainee/student is presently enrolled at this institution and is working toward a degree in a related field.
 

Supervisor's Name

 

Institution / Department

  E-mail address
7. Social and Excursions
June 10 (Wed)
Do you have interest in joining the afternoon Excursion  Yes No
 
June 11 (Thur)
Please check if you have interest in participating the "Pteridine Cup"  Tennis Golf None
8. Payment
Continue and make payment >>

 BH4 2009 :: June 7-12, 2009 - Jeju - Korea

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