EASE CONFERENCE (9-11 April 2001) 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 7 AprSun 8 Apr
Mon 9 AprTue 10 Apr Wed 11 Apr 

Partner's Accommodation:
Sat 7 Apr Sun 8 Apr Mon 9 Apr Tue 10 AprWed 11 Apr 

Costs:
 
Attendance at conference and tutorials accommodation on 9&10 April all meals 
 £ 370
Attendance at conference and tutorials morning coffee, lunch and afternoon tea, no accommodation 
£250
Attendance at conference and tutorials accommodation on 9 & 10 April all meals booked prior to 10th March
£350
Partners Rate - accommodation breakfast and dinneron 9 &10 April (includes conference dinner) 
£ 130
Additional nights including bed breakfast(pre-packeddinner on Sunday 8th April) 
£52**

** Because on-site accommodation outside of the nights of 9 &10 April is limited, if you require such
        accommodation you must notify the administrator before 10th March 2001.
 

 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 2001. Bookings after this date will be accepted at the full conference fee and will only be accepted with purchase order or credit card. Alterations and cancellations after 1st 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