QNET 2008 REGISTRATION FORM

First name:
Last name:
Affiliation:
Address (including email):


*** Dietary requirements (e.g. vegetarian):

*** Special needs (e.g. restricted mobility):

*** Workshop dinner (please write YES next to one line):

UK QNET member (paid directly from project): 

Other (UK pounds 40):

*** Do you require additional dinner tickets (UK pounds 40 each)?

If so, how many?

*** Total amount to pay:

*** Payment (please write YES next to one line):

No payment required (UK QNET member, no extra dinner tickets):

I will pay on arrival, in cash or with a UK cheque:


*** Email this form to ekashefi@gmail.com with QNET 2008
    in the title.