Application Form to the 5th International Conference on Qigong
(For Conference Attendees and for the Qigong classes)
Name……………………………….…( )m ( )f Age……Nationality……………………
(Accompanying members )
Name……………………………….…( )m ( )f Age……Nationality……………………
Name……………………………….…( )m ( )f Age……Nationality……………………
Name……………………………….…( )m ( )f Age……Nationality……………………
Name……………………………….…( )m ( )f Age……Nationality……………………
Address…………………………………………………………………………………………
………………………………………………………………………………………………….
Tel: ( )………………………Fax: ( )…………………Mob:…………………………..
Email:…………………………………………………………………………………………..
Date of Arrival:……………………………….Fligtht No.:……………………………………
Date of Departure……………………………. Flight No.:…………………………………….
Choice of Qigong Class: (Qigong classes yet to be listed)
………………………………………………………………………………………………….
Choice of Accomodation: (please tick)
( ) First Class US$80-100 per day
( ) Second Class US$50-70 per day
( ) Third Class: US$30-50 per day
Please send or fax to:
Conference contact person: : Tan Teo Song
Scorpion Holding Company Limited
10 Flr 253 Soi Asoke Sukhumvit l2 Road
Klongtoey Nua Wattana
Bangkok 10110 Thailand
www. scorpion-holding.com Tel:(66 2)260-9732-4 Fax:(662)261-9699
E-mail: scorpion@samart.co.th
