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Title * |
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First Name * |
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Name for Badge |
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Surname *
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Department
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Organisation * |
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Address * |
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Postcode * |
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Country * |
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Telephone * |
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Fax* |
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E-mail *
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Position |
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A list of attendees will be prepared and issued to people
at the meeting. If you do not want your name to be included in the list, please
tick this box: |
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A. SPECIAL
REQUIREMENTS
Please indicate any special requirements below,
i.e. diet, access etc.
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Requirements
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B. TRAVEL
I expect to travel by: 'please select from the following'
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C. POSTER
If you wish to present a poster at the meeting, please give
the title and names of co-authors below, and return a 200-300 word abstract of
the poster with this registration form
Poster Title
Co-Authors
Abstract
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D REGISTRATION
Registration fee :
The fee includes: attendance at all sessions, a booklet of
abstracts, light refreshments & lunches (11-12/9/03), dinner (11/9/03) and en
suite accommodation (11/9/03).
Accommodation for additional nights can be provided at a cost of £35 per night
10/9/03
12/9/03
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E. PAYMENT
Please note that PAYMENT MUST BE IN STERLING
(GBP),
and that provisional bookings cannot be accepted.
For payments by cheque, your registration will be held until your
payment arrives. Payments should be sent to:
cheques should be made payable to
"UMIST" and should be sent to:
“UK Polymer Colloids Forum”,
Manchester Conference Centre,
Weston Building,
UMIST,
Sackville Street,
Manchester,
M60 1QD,
United Kingdom.
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COST
GRAND TOTAL
£
*
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(sum D)
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Method of payment - click
one of options by a b c or d below, and fill in the appropriate details *
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a) By cheque or bankers draft
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Sent,
with payment made out to UMIST, to address above
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b) By credit card
Tel: +44 (0)161 200 4068
Fax: +44 (0)161 200 4070
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Visa
MasterCard
Eurocard
Switch
Issue NoCard number:
Expiry date:
Cardholder name and address:
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After a successful submission you should see a confirmation page. If you
do not receive this contact
mcc.reg@umist.ac.uk
or telephone for further assistance. Tel: +44 (0)161 200 4068
Fax: +44 (0)161 200 4070
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