Medical Congress Registration & Abstract Submission

CONFERENCE REGISTRATION FORM

YOUR DETAILS:

Title:
First Name:
Surname:

Tel No:
Email:
Fax:

Job title:
Organisation:
Address:

Postcode:

Country:

If you need visa service assistance please tick here

Name Badge Details (Please state how you would like your name badge to be displayed):

Name:
Organisation:

DELEGATE REGISTRATION FEE INCLUDES:

Admission to the two day conference
Conference Programme and Abstract booklet
Refreshments during official conference breaks
Lunch during the 2 day conference 13 & 14 November 2008
Conference Dinner Crowne Plaza 13 November 2008

REGISTRATION FEES: (please select appropriate fee)

Received before 1/8/08: £340 (dinner included)
Received after 1/8/08: £375 (dinner included)
Received after 1/10/08: £375 (dinner NOT included)
*Please add an additional £60 if you wish to attend the dinner. We cannot guarantee to accommodate guests after 1/10/08.

If you wish to bring a guest please tick here (there is an additional cost of £60)

METHOD OF PAYMENT (please select as appropriate)

Cheque
Cheque should be made payable to: 'University of Liverpool'. Please print delegate name and A/C reference number CRG10007 on back of cheque. Cheques should be posted to: Kath Pickering or Susan Kidd, University of Liverpool, Cash Office, Foundation Building, 765 Brownlow Hill, Liverpool L69 7ZX, UK

BACS (If paying by this method you must agree to pay all bank charges at the sending and receiving banks)
Bank details: Barclays Bank plc, 48 & 50 Lord Street, Liverpool, L2 1TD, U.K.
Account Name: 'University of Liverpool', Account Number: 30587532, Sort code: 20-51-01, Reference No: CRG10007.
SWIFT code: BARCGB22, IBAN number: GB15BARC20510130587532.

A BACS remittance advice should be sent for the attention of Kath Pickering or Susan Kidd at the University of Liverpool using one of the following:
by email: cash.office@liverpool.ac.uk
by FAX: 0151 708 6502
by post: University of Liverpool, Cash Office, Foundation Building, 765 Brownlow Hill, Liverpool L69 7ZX, U.K.

ACCOMMODATION:
Please book accommodation directly with the hotels at:
https://www.conferencebookings.co.uk/delegate/TMPBGCS08

CONFIRMATION OF BOOKING:
Confirmation will be forwarded by email or post.

CANCELLATION:
Cancellations received in writing, fax letter or email up to 30 days prior to the conference will receive a refund less 25% administration charge. Cancellations received after this date will be charged the full delegate registration fee.

PLEASE TICK HERE IF YOU WISH YOUR CONTACT DETAILS TO BE EXCLUDED FROM THE DELEGATE LIST.

PLEASE TICK HERE IF AN INVOICE IS REQUIRED
Please state name, address and contact details for invoicing if different from above.

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CONFERENCE REGISTRATION FORM