To register as a participant for iCON2004 follow the 2 easy steps as indicated below.

Step 1. Sending registration form :

Fill the registration form below and then click
" Submit " to send it to LYC Thailand

or

Download the application form which is in Microsoft Word .doc format. Just fill in that form, save it, and then email it as an attachment to thailand@longlyangclub.org

FAMILY NAME
GIVEN NAME
NAME/NICKNAME
(to be printed on your badge)

NATIONALITY
MAILING ADDRESS

E-MAIL ADDRESS
DATE OF BIRTH 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 Before 1944

DO YOU HAVE ANY DIETETIC RESTRICTIONS?

ARE YOU A LYC MEMBER? Yes No
WHICH CHAPTER

IF NOT, ARE YOU A MEMBER OF A CLUB OR GROUP WITH OBJECTIVES SIMILAR AS THOSE OF LONG YANG CLUB INTERNATIONAL? Yes No
NAME OF YOUR GROUP OR CLUB

DO YOU WANT SOME OF THIS INFORMATION TO BE PRINTED IN THE ICON2004 OFFICIAL BOOKLET?
YES NO

PART 2- REGISTRATION FEES AND METHOD OF PAYMENT:

THE REGISTRATION FEES INCLUDE ALL BRUNCHES, LUNCHES, DINNERS, TOURS, CRUISES, WELCOMING KIT AND MANY OTHER GOODIES. DELEGATES ARE RESPONSIBLE FOR THEIR TRAVEL AND HOTEL COSTS.

DELEGATES THAT REGISTERS BEFORE JULY 31, 2004 WILL BENEFIT THE "EARLY BIRD" SPECIAL RATE OF 240 $US.

AFTER THAT DATE AND UP TO THE START OF ICON2004 THE RATE WILL BE: 290$US

PAYMENTS ARE TO BE MADE IN $US THROUGH:

1. THE PAYPAL SYSTEM BY CLICKING ON THE "PAY NOW" BUTTON BELOW.
2. A Bank transfer to the LYC Thailand bank account.

   Bangkok Bank PCL
   The account name : James Alexander Elder
   Current Account
   account number : 101 33 66 990
   Address : 333 Silom Rd., Bangrak, Bangkok 10500
   Swift : BKKBTHBK
   Telex : BK BANK TH 82638, 82670
   Fax : 662 636 - 5699
   Tel : 662 230 - 1311

PART 3- GENERAL INFORMATION:

IS THIS YOUR FIRST TIME IN THAILAND? YES NO

WHAT IS YOUR ESTIMATED DATE OF ARRIVAL IN BANGKOK?
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 March April May June July August September October November December

AN OPTIONAL NON-COMPETITION BOWLING ACTIVITY IS PLANNED ONE AFTERNOON DURING THE CONFERENCE. DO YOU WANT TO JOIN IN?
YES NO

WAIVER:

1. The organizers of iCON2004, Long Yang Club International and Long Yang Club Thailand, their members and affiliates have no responsibility for my activities during iCON2004. I assume all risk and I shall be solely responsible, legally and financially for all my activities during my participation in iCON2004. I further agree to hold harmless the Long Yang Club International and the Long Yang Club Thailand, their members and affiliates from any expenses, damages, cost claim or lawsuit of any nature which may arise from any harm, illness, losses or damage I may suffer while participating in the program of iCON2004.
2. The registration fee is not refundable unless the organizers receive a written notice of cancellation, not later than November 01, 2004, in which case a refund of 50% will be allowed.
3. An existing registration may be transferred to another person without any charge if the organizers are informed prior to November 01, 2004. The persons involved with this transfer will be solely responsible for any appropriate reimbursement.
4. I will be responsible for making my own arrangements for personal insurance covering my travel to, from and during iCON2004, including travel delays, personal injuries and accident, sickness or any other risks, losses and mishaps which may occur during that period. I also acknowledge that, in respect of any such matters, I shall have no claims against the organizers who have no responsibility to see to my personal well-being.
5. The organizers will make all the necessary efforts to adhere to the official program. If, for unforeseen reasons some of the events have to be changed, the organizers reserve the right to do so for the smooth running of the conference.

By submitting this application form, I acknowledge that I have read this waiver and accept its terms and conditions.

THIS FORM WILL BE SENT VIA INTERNET TO
LONG YANG CLUB THAILAND.

Step 2. Payment options :

For registration fees payment click
" Pay Now " below.

or

A Bank transfer to the LYC Thailand bank account.

Bangkok Bank PCL
The account name : James Alexander Elder
Current Account
account number : 101 33 66 990
Address : 333 Silom Rd., Bangrak, Bangkok 10500
Swift : BKKBTHBK
Telex : BK BANK TH 82638, 82670
Fax : 662 636 - 5699
Tel : 662 230 - 1311