Name *

As it appears on your passport. If you have a middle name please append it at the end of "First Name"

First Name

Last Name

Title *

Mr.

Mrs.

Ms.

Dr.

Other

Category of Participation *

Faculty

Facilitator

Participant

Guest

Admin Group

Disclaimer *

You have been immunised against COVID and are willing to share your immunisation certificate with the admin - This is for the your safety and the safety of the others.

Yes

No

COVID Immunization Status *

(WHO Approved Immunization) A certificate of immunization will be requested for submission separately

Fully Immunized + Booster

Fully Immunized

Partially Immunized (WHO Approved Immunization)

I require an airport transfer for arrival *

Please note all airport transfers are from Suvarnabhumi Airport Bangkok and Pattaya Airport to the Dusit Thani Pattaya Hotel on: 1. 19 Jan 2026 for SEALA 12 Faculty and Facilitators in time for the welcome dinner 2. 21 Jan 2026 for SEALA 12 Participants in time for the welcome dinner. Any arrivals before these dates will be accommodated, however, extra room night charges will be billed directly to you by the hotel.

YES

NO

Flight Arrival Date *

The arrival date might be +/- 1 from the date you depart from your country

MM

DD

YYYY

I require an airport transfer for departure *

Please note all airport transfers are from the Dusit Thani Pattaya Hotel the Suvarnabhumi Airport Bangkok and Pattaya Airport on 1 Feb 2026 for SEALA 12 Participants, Faculty, and Facilitators. Any departures after 1 Feb 2026 will be accommodated, however, extra room night charges will be billed directly to you by the hotel.

YES

NO

Flight Departure Date *

The departure date might be +/- 1 from the date you arrive back in your country

MM

DD

YYYY