On-line Registration

1. Personal Information (All fields are mandatory.)

Name (Surname) (Given name)
Department
Affiliation
Title

Prof. / Dr. / Mr. / Ms. / others :
Address
(in English)
Country Postal Code
Mobile
Email

2. Registration (Please mark on checkbox)

Category Advanced
Registration		 On-site
Registration
International Participant

3. Deposit

Name of
Depositor

*Please indicate clearly if registrant and depositor names are different
Depoist Date Deposit Amount
Remarks

*Registration fee is non-refundable.

Korean Medical Society for Intravenous Nutritional Therapy

Secretariat: Tel.+82-2-545-1247 Fax. +82-2-540-5597 Email: kmint2014@nate.com