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Application Form
REGISTRATION IS NOW
CLOSED
Before completing this form please read the Workshop
Arrangements page and consult the methods
of payment page to decide on your preferred method. You will be
asked to notify us of your chosen method in Section 3.
All participants should complete Sections 1 to 3. Those who wish to
contribute a talk should complete Section 4. Anyone requesting
Financial Support should complete Section 5
* indicates required field |
Section 1
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Personal Details
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| *Last Name |
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| First Name |
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| *Title |
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| *Email |
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| *Institution |
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| Institution's
Address |
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| Telephone |
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| Special
requirements |
Please specify any special dietary or
other requirements
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Section 2
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Dates of Attendance
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I expect to arrive on
* (day of the week)
* (date i.e. dd/mm/yy)
and leave on
* (day of the week)
* (date i.e. dd/mm/yy) .
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Section 3
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Payment
I understand that confirmation of my place is contingent on payment of
a Registration Fee (either £130 or £45). I elect to pay by |
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(NB: This will not take you to an
online payment form.) |
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I will pay by cheque or banker's draft
in sterling.
I will pay by
Maestro (debit card).
I will pay
by credit card (add 1.75%) |
Section 4
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To be completed by Monday 2 May |
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I
would like to give a talk at the workshop
Title
Abstract
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Section 5
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Request for Financial Support |
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In order to attend this meeting I require some
financial support. Please consider me for support. I understand that
the reduced Registration Fee of £45 remains payable. |
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