REGISTRATION FORM
2013 GMO Technology Conference
The Regulation and Use of GMO Technology in Ireland
____________________________________________
Thurs.10th & Fri.11th October 2013 – The Printworks, Dublin Castle, Dublin 2
This form is to be completed in BLOCK CAPITALS
TITLE
FIRST NAME
POSITION
ORGANISATION
SURNAME
ADDRESS
MOBILE NO
E-MAIL
Event Fee: €150 OR Student Fee €100
SPECIAL OFFER: Send 2 or more delegates at Eur 125 each. OR Send two or more
students at Eur 50 per student.
Payment: must be made in advance of the event by any of the following payment methods:
•
Payment by Pay Pal, My Pay Pal address is: clara@claraclark.ie
•
Payment by cheque. (Please enclose cheque with your registration form)
Cheques payable to: Clara Clark Event Management
•
Purchase Order Numbers: an invoice will be issued quoting PO number
Please quote official Purchase Order Number: ____________________
•
Bank Transfer payment: please Email clara@claraclark.ie for bank details
Closing Date For Registration: 27 September 2013
Return form to:
Ms. Clara Clark, Clara Clark Event Management, 17 Pine Lawn,
Newtownpark Avenue, Blackrock, Co. Dublin
T: 01-289 8533; Fax: 01-2898817. Email: clara@claraclark.ie
Substitutions can be made at any time.
Cancellations after the closing date 27 September 2013 cannot be refunded.