Auxetics2012@Bolton:
4 International Conference
th
Tuesday 4th September – Thursday 6th September 2012
Registration Form
Name
Address
Email
Telephone
Fax
I will be attending on (please tick relevant option)
Tuesday 4th September 2012
Wednesday 5th September 2012
Thursday 6th September 2012
Signed
Date
Fee (incl. lunch and refreshments,
abstracts, conference dinner and
one evening meal.)
Please tick either option
Full fee £255
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Attending student £225
Presenting student £198
Dietary Requirement
Method of Payment – Please tick chosen option
Cheque
Made Payable to – The University of Bolton
Invoice
Official Purchase Order must be attached to this form
Credit/Debit
Card Payment
Please debit my:
(delete as applicable)
Mastercard, Visa, Maestro (Switch),
Electron & Solo
Card Number:
Security No.
(last 3 digits on the back of the card)
Valid From:
Expiry Date:
Switch Issue No.
(if applicable)
Signature:
Authorisation Code:
(cardholder not present)
Please return form to: Prof Kim Alderson, IMRI, The University of Bolton, BL3 5AB
Tel: +44 1204 903519; Email: ka1@bolton.ac.uk or auxetics2012@bolton.ac.uk
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