Please, complete this form in full

Full Name (including Title):


Organisation Name:

Contact Address:

Contact Information:

 Phone Number:

 Fax Number: 


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:
Sun 6 AprMon 7 Apr Tue 8 AprWed 9 Apr Thur 10 Apr 

Partner's Accommodation:
Sun 6 Apr Mon 7 Apr Tue 8 Apr Wed 9 AprThur 10 Apr 

Attendance at conference and tutorials, accommodation on 8th-9th April, all meals £390
Attendance at conference and tutorials, morning coffee, lunch, afternoon tea, no accommodation £275
Attendance at conference and tutorials, accommodation on 8th - 9th April, booked prior to 7th March £360
Partners rate, accommodation, breakfast and dinner on 8th -9th April (includes conference dinner) £140
Additional nights including bed & breakfast (pre packed dinner on Monday 7th) April) £58**

** Because on-site accommodation outside of the nights of 8 &9 April is limited, if you require such accommodation you must notify the administrator before 7th March 2003.

 Total Amount Payable: £

 Please note, payment is required in full with registration. The last date for booking, with guaranteed on-site accommodation is 7 March 2003. 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)

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

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

Last updated: 20 October 2002