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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. -- Select One -- Albania Algeria Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Canada Chile China Colombia Congo, The Democratic Republic of Costa Rica Côte Ivoire Croatia Cuba Cyprus Czech Republic Denmark Dominica Dominican Republic Ecuador Egypt El Salvador Eritrea Estonia Ethiopia Fiji Finland France Germany Ghana Greece Grenada Guatemala Guinea Guyana Honduras Hong Kong, China Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Latvia Lebanon Lesotho Libyan Arab Jamahiriya Lithuania Luxembourg Macao, China Madagascar Malawi Malaysia Mali Malta Mauritius Mexico Moldova, Republic of Mongolia Morocco Mozambique Myanmar Namibia Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russian Federation Rwanda Saint Lucia Saudi Arabia Senegal Serbia and Montenegro Seychelles Singapore Slovakia Slovenia South Africa Spain Sri Lanka Sudan Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand The F.Y.R of Macedonia Togo Trinidad and Tobago Tunisia Turkey Turkmenistan Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Venezuela Viet Nam Yemen Zambia Zimbabwe 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 >>

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