REGISTRATION FORM Sample

advertisement
Registration Form
Third biennial conference of the Society for the
Philosophy of Science in Practice
June 22-24, 2011 (Wednesday to Friday)
Held at the University of Exeter and hosted by
ESRC Centre for Genomics in Society (Egenis)
Program information: http://www.genomicsnetwork.ac.uk/egenis/events/societyforthephilosophyofscienceinpractice-conference/
Title
First Name
Last Name
Institution:
Preferred mailing address:
City:
County/Province/State:
Country:
Zip/Postal Code:
Telephone with area code:
Fax:
Email:
Are you a speaker?
Yes
No
CONFERENCE FEES
Registration Fees (All amounts are listed in pounds sterling)
Includes the conference dinner, three lunches, refreshments at breaktimes and conference booklet.
PLEASE SELECT APPROPRIATE REGISTRAION FEE:
Regular registration fee (After 1st May, 2011)
Student registration fee
Meals:
Vegetarian
POSTMARKED & PAID
£200
£150
Non-vegetarian
Other dietary requirements (gluten free etc.) Please state:
On campus accommodation
We are able to book accommodation at Holland Hall, University of Exeter, Streatham Campus
Bookings are for the nights of 21st -23rd June 2011 inclusive (three nights). All bedrooms have double beds
with ensuite facilities and breakfast is included in the price.
Ensuite accommodation: single occupancy (nights of 21st -23rd June inclusive)
Ensuite accommodation: double occupancy (nights of 21st -23rd June inclusive)
Name of accompanying guest:
TOTAL AMOUNT OF PAYMENT DUE (in GB£):
PRICE
£105
£157.50
Accessibility
Please list any special requirements you have which will make the conference more accessible for you.
Payment
PAYMENT METHOD
Please check appropriate box:


Cheque
VISA
MasterCard
Debit card
Cheques must be in £ Pounds Sterling made payable to: University of Exeter
If paying by credit/debit card, please complete the credit/debit authorisation form on the next page
Please send completed registration form with payment to:
3rd biennial conference of the SPSP
University of Exeter
Byrne House
St German’s Road
Exeter, Devon EX4 4PJ
United Kingdom
Phone: +44 (0)1392 725 140
FAX:
+44 (0)1392 724 676
Email: egenis@exeter.ac.uk
Sending card payments by fax, e-mail or telephone cannot be deemed 100%
secure due to the security weakness inherent in the global IT networks.
You should be advised that if you do, you do so at your own risk, so please
take care to protect your financial information.
Cancellations/Changes and Refunds:
Please see the full Terms and Conditions on 3rd Biennial Conference of the SPSP website
http://www.genomicsnetwork.ac.uk/egenis/events/societyforthephilosophyofscienceinpractice-conference
• A full refund of the conference booking will be made if notification of cancellation is received more than 9 weeks
prior to the conference.
• A 25% deduction will be made if notification of cancellation is received between 9 and 5 weeks prior to the
conference.
• A 50% deduction will be made if notification of cancellation is received between 5 and 4 weeks prior to the
conference.
• No refund of the conference booking will be made if notification of cancellation is made less than 4 weeks prior to
the conference.
Egenis – The ESRC Centre for Genomics in Society
University of Exeter
Byrne House
St German’s Road
Exeter, Devon
EX4 4PJ
Telephone +44 (0) 1392 725 140
Fax +44 (0) 1392 724 676
Email: egenis@exeter.ac.uk
Web: http://www.genomicsnetwork.ac.uk/egenis/
DETAILS OF PAYMENT: Registration for 3rd Biennial Conference of the SPSP
DELEGATE NAME:
FOR OFFICE USE ONLY
1 U U
U
J
J
4
1
Z - S
X 0 1 U J 8 L
0
0 0
CREDIT/ DEBIT CARD AUTHORISATION
Card Holders Name
Signature ________________________
Credit Card
Debit Card
Card Number
Start Date
Expiry Date
Debit Card Issue No. (If applicable)
Security Number (last 3 digits of number on signature strip)
Cardholder’s address (including Postcode)
Cardholder's telephone no.
Amount authorised to be paid using the above card details:
Total (GB£)
£
p
We do not recommend returning this form by fax or e-mail, since these methods cannot be deemed 100% secure due to the
security weakness inherent in global IT networks. Be advised that if you do so, it is at your own risk.
Name:
Amount:
Download