Programme

REGISTRATION


2nd International Presence Workshop

REGISTRATION ONLY £50

FREE REGISTRATION FOR STUDENTS
(
Studying for degrees of M.Phil. or Ph.D. and presenting a paper.)


Please print this page out, fill it in with your details and either:

You will receive email confirmation of your registration as soon as your form has been processed.

NOTE: The University CANNOT process American Express or Diner's Club credit cards

Family Name

………………………………………………………………………………………

First Name(s)

……………………………………………………………………………………….

Have you contributed to a paper?

YES NO

Are you planning to present?

YES NO

Title of Paper:

……………………………………………………………………………………….

……………………………………………………………………………………….

Affiliation:

……………………………………………………………………………………….

(name of university / business to which you are attached)

Address:

……………………………………………………………………………………….

 

……………………………………………………………………………………….

email:

………………….

Telephone Number:

…………………………………..

   

Fax Number:

…………………………………..

PAYMENT DETAILS

Payment Method*

CHEQUE

Payable to: University of Essex

(*tick as applicable)

VISA

Please fill in below, authorisation for credit card payment/ statement for cheque payment:

MASTERCARD

   

Cheque: I enclose………………………………………………………..

£_______

Credit Card: I authorise you to debit my account with the amount of:….

£_______

Credit Card Details:

Card number:

 

Expiry Date:

 

(mm/yy)

 

Cardholder's Name:

(where different from above) ……………………………………………….

Cardholder's Address:

……………………………………………………………………………………….

(registered to card)

……………………………………………………………………………………….