TH-ex-design

1. Participant Information (Please fill in the blanks below.)

First Name

Last Name

Country

Affiliation

Address

E-mail

Tel. (Incl. Country Code)

Mobile Phone (Incl. Country Code)

2. Hotel & Room Type

Hotel Name & Room Type, Room Rate

Check-in Date

Check-out Date

Room Share With

No. of Person

No. of Night

Special Request

3. Payment Method

※ Credit Card (Option 1) or Bank Transfer (Option 2)
※ Please select either a credit card or a bank transfer and fill in the payment information.

Option 1: Credit Card

Card Type VISAMasterAMEX

Card No.

Expiration Date(mm/yy)

*CVC Number

Card Owner

Card Owner’s Sign

*CVC Number: 3 figures digit number on back side of the card.
*I authorize GTN Co., Ltd. to charge the credit card indicated on this form. YesNo

Option 2: Bank Transfer
Bank Name & Branch:	TBI
Bank Address:	TBI
Account No.:	TBI
SWIFT Code:	TBI
Account Holder:	GTN CO., LTD.
Sender's Name:	(Please write down if the sender's name differs from the participant's name.)
※ The remittance fee is borne by the senders. ※ Be sure to send a copy of the remittance receipt by email to corl2025.hb@gmail.com upon request