Registration Form for Adoptive Families The 9th Nativeland Visit Program 6th - 14th July 2019 ------

PLEASE TYPE OR WRITE IN CAPITAL LETTER CLEARLY AND RETURN IT NOT LATER THAN 15th May 2019 Name and Family Name: …………………………………………………………………………………… Address : ……………………………………………………………………………………………………. ………………………………………………………………………………………………………………….. Country………………………………………………………………………………………………………… Phone (Area Code) : …………………………………………………Fax : ……………………………..… E –mail : ………………………………………………………………………………………………………

Please give the details of the participants and attach Copies of Passports;

Name of The former name Sex Date of No. Family Name First Name Age Children’s Home of the child M/F Birth in care (Thai name)

1. Details of Flights Arrival date: ………………………Arrival Flight No. : ……………… Estimated time of arrival …………. Departure date :………………….Departure Flight No. :………….. Estimated time of departure ……… Note : The Child Adoption Center will provide transportation to pick up you from Suvarnabhumi Airport to the hotel in on 4th July and 5th July (Flight landing within midnight)only.

2. Request for program registration : the itinerary please see the attachment (Please check  the program you would like to participate in)  Only Bangkok Program during 6th -10thJuly 2019  Only Northeastern Program during 11st -14th July 2019  The Whole Program in Bangkok and Northeastern Program during 6th -14th July 2019 -2-

3. The Children’s Home you would like to visit Bangkok Program : on 10th July 2019

(Please check  the place you would like to visit)  Phyathai Babies’ Home in joins with Songkhla Home for Children  Pakkred Babies’ Home in Nonthaburi Province joins with Si Thammarat Home for Boys  Rangsit Babies’ Home in joins with Viengping Children’s Home  Other Children’s Home ......

Northeastern Program: on 13rd July 2019

Home for Girls, Udon Thani Province  Kanthong Children’s Home,

4. The Workshop on the subject “Guidelines for root search and the preparation on the first meeting of the adopted child and his/her biological parents” Bangkok Program : on 7th July 2019

Free of charge and limit only 150 participants attending the workshop (Please check  the program you would like to participate in)

 Participation in the workshop total …………………………… person(s)  Not participate

5. Details of Accommodation 5.1 Bangkok Program: Royal Orchid Sheraton Hotel during 6th– 10th July 2019. (Total 5 nights) In Program : Check - in date : 6th July 2019 : Check - out date : 11st July 2019 Check - in time : 15.00 hrs. Check - out time : 12.00 hrs. Cost of Accommodation: Superior Room Rate : Single Bed /Twin Bed / Double Bed = 3,500 Thai Baht/night/room Extra Bed = 1,500 Thai Baht/night/bed

Room(s) booking in Program: Room Types Grand Total Total of Single Bed Total of Twin Bed/ Total of Extra Bed Room(s) booking (for one person) Double Bed - 3 –

Pre or Post Stay at the Royal Orchid Sheraton Hotel, Bangkok If you would like to extend your stay for extra night with the same rate in program (Pre and Post stay we provide only 3 days prior and 3 days after the program). Other nights, please contact with the hotel directly - Requirement of Pre Stay before 6th July 2019 Check - in date ……….……………………………… Check - out date …………………………………….. Room(s) booking for Pre Stay before 6th July 2019:

Room Types Grand Total Total of Extra Bed Total of Single Bed Total of Twin Bed/ Room(s) booking (for one person) Double Bed

- Requirement of Post Stay after 10th July 2019 Check - in date ……….……………………………… Check - out date …………………………………….. Room(s) booking for Post stay after 10th July 2019:

Room Types Grand Total Total of Extra Bed Total of Single Bed Total of Twin Bed/ Room(s) booking (for one person) Double Bed

5.2 Northeastern Program: Centara Convention Center Udon Thani, Udon Thani Province

during 11st - 14th July, 2019 (Total 3 nights) In Program : Check - in date : 11st July 2019 : Check - out date : 14th July 2019 Check - in time : 15.00 hrs. Check - out time : 12.00 hrs. Cost o f Accommodation: Superior Room Rate : Single Bed for one person = 1,200 Thai Baht/night/room Twin Bed / Double Bed = 1,500 Thai Baht/night/room Extra Bed for 12 years old up = 750 Thai Baht/night/Bed Extra Bed for under 12 years old = 400 Thai Baht/night/Bed Room(s) booking in Program:

Room Types Grand Total Total of Extra Bed Total of Single Bed Total of Twin Bed/ Room(s) booking (for one person) Double Bed - 4 -

Pre or Post Stay at the Centara Convention Center Udon Thani, Udon Thani Province If you would like to extend your stay for extra night with the same rate in program (Pre and Post stay we provide only 3 days prior and 3 days after the program). Other nights, please contact with the hotel directly

- Requirement of Pre Stay before 11st July 2019 Check - in date ……….……………………………… Check - out date ……………………………………..

Room(s) booking for Pre Stay before 11st July 2019:

Room Types Grand Total Total of Extra Bed Total of Single Bed Total of Twin Bed/ Room(s) booking (for one person) Double Bed

- Requirement of Post Stay after 14th July 2019 Check - in date ……….……………………………… Check - out date …………………………………….

Room(s) booking for Post Stay after 14th July 2019:

Room Types Grand Total Total of Extra Bed Total of Single Bed Total of Twin Bed/ Room(s) booking (for one person) Double Bed

Remark : 1. The cost of both accommodation is reasonable and very special price for “The 9th Nativeland Visit Program” 2. If you would like to check in before 15.00 hrs. or check out late after 12.00 hrs., you will be charged from the hotel. Please contact the hotel directly. 3. The hotel limit the number of Extra Bed, therefore, the hotels will allocate Extra Bed from the queue of reservation. 4. One room is available for one Extra Bed. 5. Payment : Please arrange your own payment and contact directly to the hotels both in Bangkok and Udon Thani province. We will only make a reservation for you. The hotels will contact you about the payment after reservation. - 5 -

6. Cost of Activities

6.1 Bangkok Program : Tuesday 9th July 2019 : one day trip in

Visiting : Ecological and cultural excursions to the Thai Buffalo Conservation Village and Bueng Chawak Aquarium, Suphan Buri Province

Cost of one day trip in Suphan Buri Province including transportation (VIP bus), lunch, entrance fee and tour guide

 Free for children (under 3 years) total………………… person(s)  3,300 Thai Baht per 1 child (4 –12 years) total………………… person(s)  3,600 Thai Baht per 1 child (13 – 18 years) total………………… person(s)  4,000 Thai Baht per 1 adult total………………… person(s)  No participation / joining total………………… person(s)

6.2 Northeastern Program : During 11st - 14th July, 2019 Visiting : 3 places

-11st July 2019 : Cultural and historical excursions at National Museum, Udon Thani Province. -12nd July 2019: Historical excursions at the Phu Kum Khao Study and Research Center(Siridhorn Museum), (Approximately190 kms. from Udon Thani Province for visiting Dinosaurs such as T-rex, Triceratops, Velociraptor, Apatosarus and etc.) -13rd July 2019 : Transportation for Visiting Group 1 : Udon Thani Home for Girls, Udon Thani Province Group 2 : Kanthong Children’sHome, Khon Kaen Province (Approximately 120 kms. from Udon Thani Province) (Lunch is offered by the Department of Children and Youth)

Cost of Northeastern Program during 11st- 14th July, 2019 is the package tour including transportation (VIP bus), 2 lunches, 2 dinners, entrance fee and tour guide

 Free for children (under 3 years) total ………………… person(s)  9,500 Thai Baht per 1 child (4–12years) total ………………… person(s)  11,000 Thai Baht per 1 child (13 – 18 years) total ………………… person(s)  12,000 Thai Baht per 1 adult total ………………… person(s) - 6 -

Payment for Bangkok Program (one day trip in Supan Buri province) and Northeastern Program : 1. The Child Adoption Center assigns SAWASDEE HOLIDAYS CO., LTD. to arrange the trips both in Bangkok Program and Northeastern Program. 2. Total cost of the program you selected must be transferred to the account of the said Tour Agency “SAWASDEE HOLIDAYS CO., LTD.”. The Child Adoption Center will only make tour reservation for you.The said Tour Agency will contact you directly about the payment after reservation. 3. Payment of the bank fee is excluded (both in your country and ).

Flight Booking from Bangkok to Udon Thani Province for joining the Northeastern Program :

For the whole program in Bangkok and Northeastern program during 6th - 14th July 2019. The Child Adoption Center assigns SAWASDEE HOLIDAYS CO., LTD. to book flight for the family who join the whole program only which is the flight booking from Bangkok to Udon Thani Province on 11st July 2019. Total cost of flight booking, the tour agency “SAWASDEE HOLIDAYS CO., LTD.” will book a flight for you and you have to pay directly to the said Tour Agency. The said Tour Agency will contact you directly about the payment after reservation.

Note : The participants have to arrange the trip back from Centara Convention Center Udon Thani, Udon Thani Province by themselves. : On Sunday 14th July 2019, the transportation from Centara Convention Center Udon Thani, Udon Thani Province to Udon Thani International Airport is provided. : Please return this form not later than 15th May 2019.

Special request: ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………

Confirmed by (Signature)......

(Mr./Mrs./Miss)......

Date…………………………………………………………………………………

Contact person: 1. Mrs. Prapimdao Satake, Director of Child Adoption Center 2. Ms. Chanthip Vatanasusakun, Director of Post Adoption Services Group

E-mail : [email protected] CC: [email protected] Additional Note

Saturday 6th July 2019 : Registration and opening ceremony - No lunch - Dinner included

Sunday 7th July 2019 : workshop and Sports competition For the participants who attend the workshop - 1 Break included - Lunch included For the Sports competition to celebrate the 40th anniversary of the Child Adoption Center - Light meal/refreshment included - No dinner

Monday 8th July 2019 : Meeting and paying a courtesy call on the Prime Minister or another government administrator - No lunch - No dinner

Tuesday 9th July 2019 : One day trip in Suphan Buri Province - Lunch included - Afternoon light meal/refreshment included - No dinner

Wednesday 10thJuly 2019 : Visit the Babies’ Home - Lunch is offered by the Department of Children and Youth - No dinner

Thursday 11st July 2019 : Ban Chiang National Museum, Udon Thani Province - Lunch included - Dinner included

Friday 12nd 2019 : Historical Excursions at the Phu Kum Khao Study and Research Center, (Siridhorn Museum), Kalasin Province - Lunch included - Dinner included Saturday 13rd July 2019 : Visit the Babies’ Home and Farewell Party - Lunch is offered by the Department of Children and Youth - Dinner included

Sunday 14th July 2019 : Facilitate adoptive families and adopted children to travel back home - No meals

** Both Hotel room rate: Breakfast included