EASE CONFERENCE (12 - 14 April 1999) REGISTRATION FORM

Please, complete this form in full


Full Name (including Title):

MaleFemale

Organisation Name:

Contact Adress:


Contact Information:

 Phone Number:

 Fax Number: 

E-Mail: 


Diet and Other Information:

 Are You Vegetarian ? 

Special Requirements (please give details)


Accommodation Information::

 Accommodation Required  None Single Room Twin Bedded Room 
Please tick dates required:
Sat 10 AprSun 11 Apr Mon 12 AprTue13 Apr Wed 14 Apr 

Partner's Accommodation:
Sat 10 Apr Sun 11 Apr Mon 12 Apr Tue 13 AprWed 14 Apr 

Costs:
    1. Attendance at conference and tutorials, accommodation on 12 &13 April, all meals                                £ 310
    2. Attendance at conference and tutorials, morning coffee, lunch and afternoon tea, no accommodation       £ 220
    3. Partners Rate - accommodation, breakfast and dinner on 12 &13 April (includes conference dinner)      £ 120
    4. Additional nights including bed, breakfast and evening meal (pre-packed dinner on 11 April)                  £   52 **
 
    ** Because on-site accommodation outside of the nights of 12 &13 April is limited, if you require such
        accommodation you must notify the administrator before 15 February 1999.
 

 Total Amount Payable: £

 Please note, payment is required in full with registration. The last date for booking, with guaranteed on-site accommodation is 10 March 1999. Conference bookings will be accepted until 30th. March, but may attract additional charges if off-site accommodation has to be found.Invoices will only be issued if a purchase order
accompanies this registration form. All prices quoted are in pounds sterling. Cheques should be made payable to
"Keele University" by a crossed cheque drawn on a British bank or by Banker's Draft.
Alternatively, payment may be made by Credit Card.
Please note this is an insecure transaction, if you wish to fax or mail see below.
 Method of Payment: Cheque Credit Card Purchase Order (give number) 

To pay by Credit Card please provide the details below:
Visa Eurocard Mastercard
Card Number: Expiry date:
Billing Address for the Credit Card: (if different from the address given)

Date:
Signature:
Keele Fax No. +44 (0) 1782 713082
Address: Ease, Dept of Computer Science, University of Keele, Keele, Staffs. ST5 5BG, UK 




 
 
 
Steve Linkman, steve@cs.keele.ac.uk

Last updated: 8th February 1999