Registration Form

Print out and fax to: +44 (0) 1865 375855

Please complete in block capitals

 

Title :
First Name:
Last Name:
Position:
Institution:
Address:
Post/ZIP Code:
Country:
Tel:
Fax:
E-mail:
Nature of business:
Special dietary requirements:

Please register me:

	Industry delegates - US $390
	Academic delegates - US $270
	Authors - US $270 (author rate applies to one author of each paper accepted for presentation)
	Students - US $120

TOTAL COST US$ (excluding accommodation).

Payment

	I enclose a check made payable to Elsevier Science Ltd
	I have arranged a bank transfer to Elsevier Science Ltd, National Westminster Bank plc, 21 Lombard Street, London EC3P 3AR, UK; for the account of Elsevier Science Ltd; Sort Code 60-00-01, US$ Account No 40018717 It is essential that you include the reference NAID, the delegate name(s) and organization name on all bank transfer documentation. Please forward a copy of your bank transfer confirmation to the conference secretariat.
	Please charge my Visa/Amex/Mastercard/Eurocard (delete as applicable)

 

Card No:
Expiry Date:
Today's Date:
Name and address of cardholder if different from above
Name
Address
Post/Zip Code

I understand an agree to abide by the terms as set out in this brochure.

 

Signature___________________________

Date____________________

Return to:

Gill Heaton
NIAD 2000 Secretariat
Hillside Cottages
Wheatley Road
Islip, Oxford OX5 2TF
UK

Tel: +44 (0)1865 373625
Fax: +44 (0)1865 375855
E-mail: gill.heaton@virgin.net

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