EVENT REGISTRATION June 23, 2016 (9.00 – 17.00) When : Fee: Where : Title Mr. Mrs. Ms. Dr. Other (Please specify)…………………………………………… Full name in Thai: …………………………………………………………………………………………………. Full name in English: ……………………………………………………………………………………................... Position: ………………………………………………………. E-mail:………………………………………......... Tel. or mobile ……………………………………………………………………………………………….. Company name: …………………………………………………………………………………………………… Address: ………………………………………………………………………………………………………………... Postal code: …………………………………………………………………………………………………………. Contact Person:………………………………………………………………………………………………………. E-mail: ……………………………………..………………… Tel. …………………………………… When : Fee: Fee Fee per one delegate 3,500.- Plus: VAT 7% 245.- Total paid amount (Baht) 3,745.- June 23, 2016 (9.00 – 17.00) Where : PULLMAN BANGKOK GRANDE SUKHUMVIT 30 SUKHUMVIT 21 (ASOKE) ROAD BANGKOK 10110 – THAILAND Tel. 02 204 4039 Total paid amount for corporate only: (หักภาษี ณ ที่จ่าย 3% เฉพาะชำระโดยนิติบุคคลเท่านั้น) Deduct: Withholding tax 3% 3,640.- Bank information: please transfer money to: Pay-in "Thailand Marketing Research Society" (สมาคมวิจัยการตลาดแห่งประเทศไทย) UOB Bank, Amarin Plaza Branch Saving Acct no: 704-123-863-5 Swift Code: UOVBTHBK Please fax Registration form/pay-in slip to: Fax : 02 697-0200 Or email: info@tmrs.or.th or Supalak.Chaiporapak@ipsos.com 3 Step to secure your seat : Email or fax the registration form Email or fax payment slip Confirmation of your registration will be email (with ticket number) within 5 working days. Please contact TMRS if your registration is not confirmed within this timeline Terms & Conditions: TMRS reserves the right to alter the program without notice including the substitution, alteration or cancellation of speakers and topics of the event.