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Registration Form for the 2023 Academic Conference
between November
at Jatuthit Room, 3rd floor, Golden Tulip Hotel, Bangkok
Medical Student
Nephrology
General Physician
Nurse
Pharmacist
Other ................................................
Name ..............
.........................................Last Name...............
Hospital/Department ......................
..............................................................................................................
ID Card Number ........................
Medical/Patient License Number ................
Mobile Number ...............
...............................
(Write clearly)
..............
......

➢Please specify the name and address of the receipt recipient (the registrant must pick up the receipt at the conference)
➢Payment method
Transfer to Thai Commercial Bank account number 043-2-52079-9, account name "Thai Nephrology Association"
For more information, contact Khun Pichaya Saeheng / Khun Nanthika Tatong
Phone 02-716-6091 / 02-716-7450 or
• Send this form with a transfer slip to
The registrant will be able to access
from December 1 - 31, 2023, for a period of 1 month
Registration fee
Member of the Nephrology Association and the Nephrology Nursing Association

3,000 baht
Non-member of the Nephrology Association and the Nephrology Nursing Association

3,500 baht

After November 10, 2023)


4,000 baht