EASE CONFERENCE (17-19 April 2000) REGISTRATION FORM

Please, complete this form in full


Full Name (including Title):

MaleFemale

Organisation Name:

Contact Address:


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 15 AprSun 16 Apr
Mon 17 AprTue18 Apr Wed 19 Apr 

Partner's Accommodation:
Sat 15 Apr Sun 16 Apr Mon 17 Apr Tue 18 AprWed 19 Apr 

Costs:
    1. Attendance at conference and tutorials, accommodation on 17 &18 April, all meals                                        £ 330
    2. Attendance at conference and tutorials, morning coffee, lunch and afternoon tea, no accommodation       £ 220
    3  Attendance at conference and tutorials, accommodation on 17 &18 April, all meals booked
         prior to 10th March                                                                                                                                                              £ 310
    4. Partners Rate - accommodation, breakfast and dinner on 17 &18 April (includes conference dinner)         £ 120
    5. Additional nights including bed, breakfast and evening meal (pre-packed dinner prior to 17th April)         £   52**

** Because on-site accommodation outside of the nights of 17 &18 April is limited, if you require such
        accommodation you must notify the administrator before 10th March 2000.
 

 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 2000. Bookings after this date will be accepted at the full conference fee. Alterations and cancellations after 7th April will have an additional charge applied. 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: 14th February  2000