Please fill out this form completely and legibly, thankyou...
Full Name:___________________________________________________________________________
Institution:_________________________________________________________________________
Home Address:________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________Postcode:___________________________
Phone (h):_______________________________________(w):________________________________
Fax:_____________________________________________E-Mail:_____________________________
Smoking?:[]Vegetarian?:[]I enclose £50 as DEEP membership to claim my 10% discount:[]
I enclose a £50 booking deposit to book a conference place at a delegate rate of:
Institutional Rate £285 [ ] Individual Rate £195 [ ]
DEEP Institutional Rate [ ] DEEP Individual Rate [ ]
I wish acomodation to be booked on my behalf for the nights of Thursday 10th, Friday
11th and Saturday 12th September at a cost of:
Accomodation only £33 [ ] Ensuite £42 [ ]
With full Welsh breakfast £45 [ ] Ensuite £54 [ ]
or
Please send me an accomodation list so I can
make my own arrangements [ ]
If you have any special requirements, or need assistance on issues such as childcare,
diet, access or signed interpretation, please enclose a brief letter with details, so
that we can try to ensure advance arrangements are made as far as possible.
Signed:________________________________________________________________Date:__________
(Flyer received on the Website)