CREATE ACCOUNT

Registration Form

Thai Participant
15^th Thai Annual Orthopaedic Trauma Congress (TOTAC) 2027
February 17-19, 2027
@ The Heritage Grand Khon Kaen Hotel and Convention, Khon Kaen, Thailand

license Number Number Only (if you're RCOST member, Resident, Fellow, please fill in the license number)

Type Registration *

Prefix *

Name (TH) *

Surname (TH) *

Name (ENG) *

Surname (ENG) *

Present Office / Institution *

Mobile *

Email *

Confirm Email *

ปีเกิด(พ.ศ.)

Payment

Please pay

Cheque pay

Transfer

Account Name: THAI ORTHOPAEDIC TRAUMA SOCIETY (TOTS)
Account no: 051-282970-4
Bank Name: Siam Commercial Bank Public Company Limited
Bank Branch: Rajvithi Hospital Branch
Bank Address: Rajvithi Hospital, Rajavithi Rd., Rajthevee, Bangkok 10400,Thailand.
Swift code: SICOTHBK

Bank Name *

Payment Date *

Payment Time *

Payment Amount *

Currency *

Proof of Payment (*.jpg, *.jpeg, *.png Only)
if Type Registration is RCOST Senior Member Please Attach ID. Card

Receive a receipt.

Tax ID. *

The name specified on the receipt *

The address specified on the receipt *

Contact: Miss Jutamas Chearanaya
The Royal College of Orthopaedic Surgeons of Thailand
4th floor, the Royal Golden Jubilee Building, 2 Soi Soonvijai, New Petchburi Road, Huaykwang, Bangkok 10310, THAILAND
Tel. (662) 716-5436-7 E-mail: [email protected]

Secure Image

Input Security Code *