CIMPA-UNESCO-MESR-MINECO-THAILAND research school
Graphs, Codes, and Designs (GCD)
May 20 &31, 2013. Ramkhamhaeng University, Bangkok, Thailand
REGISTRATION FORM
Return the form to:
Mathematics Department, Faculty of Science, Ramkhamhaeng University, Bangkok 10240, Thailand
www.cimpa2013.ru.ac.th Tel: +66(0) 2310 8388 Fax: +66(0) 2310 8388 Email: [email protected]
Section 1: Personal Information
Title
Professor
Associate Professor
Assistant Professor Dr. Mr.
Mrs. Ms.
Others, please specify..
First name
Last name
Gender
Male
Female
Institution
Position
Latest degree
Section 2: Contact Information
Address
State/City
Postal Code
Country
Telephone
Fax
Mobile Phone
E-mail
Research area of interest / Area of study
Section 3: Special Requirement
Special Dietary Requirement? Yes*
No
*If yes, Vegetarian Halal Diabetic Others, please specify
Section 4: Contributed Talk
Would you like to give a 25 minute contributed talk?
Yes* No
Title
*If yes, please submit abstract of your intended talk by March 17, 2013.
Please fill in the form and send it back by mail or email or fax to the following address :
(Deadline for Registration: March 17, 2013)
Sirirat Singhun
Mathematics Department, Ramkhamhaeng University
Ramkhamhaeng rd., Huamark, Bangkapi, Bangkok 10240 Thailand
Tel:+66 2 310 8388 Fax: +66 2 310 8388
Email: [email protected]
1