TSB Application Form (English) - TSB2011

minerbendBiotechnology

Feb 12, 2013 (4 years and 7 months ago)

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APPLICATION FORM

THAI SOCIETY FOR BIOTECHNOLOGY


Thai Society for Biotechnology

National Center for Genetic Engineering and Biotechnology

73/1

Rama VI Rd
.
, Bangkok
10400

Tel
. (66
-
2)
644

8150

Ext
.
407


Fax
. (66
-
2)
644

8079


E
-
mail
:
tsb@biot
ec
.
or
.
th


Please Fill


1.

Name
(
Mr
.
Mrs
.
Miss
)............................................................................................................


…….


2.

Occupation………………………………………………………………………………


3.

Places To Contact

( ) 1.
Home

( ) 2.
Office


Address……………………………………………………………………………………


No
.
……………Road
......................
………………………District
..........................
………………


Province
............................
………………Country
.................
… ……………Zip Code………



Tel
.............
.....
………………………… Fax
...............................................................
……………
..



4.

Application Fee $
40 (
membership & postage handling for Thai Journal of Biotechnology
)



................................................................






(
Signature
)





......./......../..........




































ำหรับเจ้ำหน้ำที่

เลขที่สมำช

ก........................................

วันรับเป็นสมำช

ก.................................

รับเงินตำมใบเสร็จเล่มที่............เลขที่........

ลงช
ื่
อ.....................
......
.......................





DATABASE OF TSB’S ME
MBER


1.

NAME
-
SURNAME

(
Mr
.
,Mrs
.
,Ms
.)...................................................................................................
…………………
……………….

2.

BIRTH DATE
..
………………………………………………………..…………………..

3.

Office address………………………………………………………………………...……

No
.
……………Road
.....................

………………District
..........................
…………… …………
.

Province
............................
…… ……
..
Country
.................

… … ……
..
Zip Code………………


Tel
..................
………………… ………………… Fax
...............................................................................


Home Address No
.
……………Road
......................
…… ………District
..........................
…… …


Provin
ce
............................
…….. Country
.................
…… …………..Zip Code………………


Tel
..................
……………………….…… … Fax
...............................................................
……………
..

4.

Occupation ………………………..……………………………………
.
………………


Position………………………………………….……………………………………
...

5.

E
-
mail Address ……………………………….…………………………………………
..

6.

Web Site …………………………………………………………………………………
.

7.

Education…………………………
.
branch………………………………………………


Institute…………………………………………………Year…………………………

8.

Field of Specialization
/
I
nterested
(
can use more one choice
)

( )

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( )

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( )

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( )

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( )

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( )

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( )

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( )

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( )

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y

( )

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( )

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( )

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( )

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( )

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( )

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( )

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( )

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( )

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( )


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