2nd International Presence Workshop
REGISTRATION
ONLY £50FREE REGISTRATION FOR STUDENTS
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Please print this page out, fill it in with your details and either:
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Family Name |
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First Name(s) |
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Have you contributed to a paper? |
YES NO |
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Are you planning to present? |
YES NO |
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Title of Paper: |
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Affiliation: |
. (name of university / business to which you are attached) |
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Address: |
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email: |
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Telephone Number: |
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Fax Number: |
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PAYMENT DETAILS |
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Payment Method* |
CHEQUE |
Payable to: University of Essex |
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(*tick as applicable) |
VISA |
Please fill in below, authorisation for credit card payment/ statement for cheque payment: |
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Cheque: I enclose .. |
£_______ |
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Credit Card: I authorise you to debit my account with the amount of: . |
£_______ |
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Credit Card Details: |
Card number: |
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Expiry Date: |
(mm/yy) |
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Cardholder's Name: |
(where different from above) . |
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Cardholder's Address: |
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(registered to card) |
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