ANNUAL CONFERENCE 2009

14th to 16th April, University of Teesside, UK

Registration Form

Please complete in block letters and return with payment details to

First Name: / Last Name:
Sex: /
Male/Female* Title:
Institute:
Address:
Telephone: / Fax:
E-Mail: / URL:
Name to Appear on Conference
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Conference Fees

iIIRG Members

Please tick
Whole conference(inclusive of conference pack; presentations; drinks/refreshments and lunches at the University of Teesside throughout the conference; hot buffet at the Thistle Hotel, Middlesbrough* on first evening; reception drinks and conference dinner to be held at the Thistle Hotel on second evening with wine/fruit juice. / Early - £200
(before 15th Dec 08)
Late - £250
(after 15th Dec 08)
Tuesday14thApril 2009 (inclusive of conference day pack, presentations, drinks/refreshments and lunches at the University of Teessidethroughout the day) / £120
Wednesday 15thApril 2009(inclusive of conference day pack, presentations, drinks/refreshments and lunches at the University of Teessidethroughout the day) / £120
Thursday 16th April 2009 (inclusive of conference day pack, presentations, and refreshments during morning) / £60
TOTAL / £

Non-iIIRG Members

Whole conference(inclusive of conference pack; presentations; drinks/refreshments and lunches at the University of Teesside throughout the conference; hot buffet at the Thistle Hotel, Middlesbrough* on first evening; reception drinks and conference dinner to be held at the Thistle Hotel on second evening with wine/fruit juice. / Early - £250
(before 15th Dec 08)
Late - £300
(after 15th Dec 08)
Tuesday14thApril 2009 (inclusive of conference day pack, presentations, drinks/refreshments and lunches at the University of Teessidethroughout the day) / £120
Wednesday 15thApril 2009(inclusive of conference day pack, presentations, drinks/refreshments and lunches at the University of Teessidethroughout the day) / £120
Thursday 16th April 2009 (inclusive of conference day pack, presentations, and refreshments during morning) / £60
TOTAL / £

Students

Whole conference(inclusive of conference pack; presentations; drinks/refreshments and lunches at the University of Teesside throughout the conference; hot buffet at the Thistle Hotel, Middlesbrough* on first evening; reception drinks and conference dinner to be held at the Thistle Hotel on second evening with wine/fruit juice. / Early - £150
(before 15th Dec 08)
Late - £180
(after 15th Dec 08)
Tuesday14thApril 2009 (inclusive of conference day pack, presentations, drinks/refreshments and lunches at the University of Teessidethroughout the day) / £65
Wednesday 15thApril 2009(inclusive of conference day pack, presentations, drinks/refreshments and lunches at the University of Teessidethroughout the day) / £65
Thursday 16th April 2009 (inclusive of conference day pack, presentations, and refreshments during morning) / £35
TOTAL / £

Student Bursary Offered? Yes/NoApplication/Acceptance Number:

I enclose a cheque for £______made payable to the University of Teesside OR:
Please invoice £______to ______at ______
______
I hereby authorise the University of Teesside to charge my credit/debit card £______
Card type (e.g. Visa,/ Mastercard/ Switch)______(AMEX not accepted)
Card number: |_|_|_|_|_|_|_|_|_|_|_|_|_|_|_|_| Valid from: |_|_| / |_|_| Expires end: |_|_| / |_|_|
Security No. (last 3 digits on signature strip)……… Issue No. (Switch only):………………
Billing address: ______
Name as it appears on card: ______(this needs to be exact)

Cancellation/Refund Policy

Before 30th January - 75% refund

Between 31st January and 28th February - 50% refund

After 28th February - nil refund

The information provided above (your full name, title, organisation and e-mail address) will be used to complete a list of delegates to be distributed at the conference. Please tick the box to give your permission to include this information

For up-to-date information about the conference, please visit the iIIRG website at

Return this form electronically to: