Registration Form for 7th AAHRS Meeting

Registration Form for 7th AAHRS Meeting

JULY 20-23, 2023
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
General PhysicianDermatologistHair Transplant SurgeonPlastic SurgeonTrainee/FellowPhysician's assistantOther
Medical License Number
Country of Medical Licensure
MeetingMeeting and gala dinner
Yes ( life time membership )Yes ( annual membership) and I want to be a life time member.No
If yes, please upload certificate of AAHRS Membership

Cancelof
PAYMENT DETAILS (BANK TRANSFER ONLY. Credit card payment not available)

Account Details

Account Name: AAHRS by Damkerng Pathomvanich

Account Number: 014273762-8

Bank Name: Siam Commercial Bank Ltd

Bank Branch: Phahonyothin Branch

Swift Code: SICOTHBK

Bank Address: SIAM COMMERCIAL BANK, Phahonyothin Branch 408/5 Phahonyothin Place Building, Phaholyothin Road, Phayathai, Bangkok 10400, Thailand

Bank Phone Number: +662-2710371

**Once you have made payment, please send deposit slip information to: aahrs2023bkk@gmail.com**

We will send receipt confirmation in two weeks
Please use the link below for special room price in Pullman King Power Bangkok Hotel (subject to availability):

https://www.idem.events/r/e-asian-association-of-hair-restoration-d3bea802
Should be Empty: