COMVEBONOV SYMPOSIUM (27-28 March 2012) -- Registration Form
School of Engineering and Informatics, Room 007, Chichester 1 Building, 
University of Sussex, Falmer, Brighton BN1 9QJ.

Email: comvebonov.symposium@sussex.ac.uk

Please complete this form, sign it, and send it to us either (a) by post to the address above or (b) by Fax to +44 (0) 1273 877873.  Mark your letter or Fax “For the attention of Mr Richard Chambers”.

A.  Contact Information

Title and Name
	Prof.   /   Dr.   /   Mr.  /  Mrs   /    Miss  /  Ms.	     	
Institution
	     	
Full postal address

	     	
Email
	     	
Telephone
	     	

B.   Participation

I am a              Presenting Author            Non-presenting Author            Non-author participant.

C.  Registration options

   “Early Bird” Registration @ £199.   Only available until 31st January 2012.    OR
    Standard Registration @ £249.   Available after 31st January 2012

D.  Symposium Dinner

   Vegetarian            Non-Vegetarian   
  
E.  Payment information.

There three options for paying registration fees.   Please check the appropriate box below.

Payment Option 1.  	By cheque.  Cheque must be in UK sterling made payable to ‘University of Sussex’.
Payment Option 2.  	Direct bank transfer.  Send us this completed registration form.  We will send you bank transfer details by email.
Payment Option 3.  	Credit Card payment.  Please complete all information in the table and sign below.

Name as on the card	     
	
Type of card	Visa    /   Mastercard   /    American Express	
Card number (at least 16 digits)	     	
Card expiry date	     	
Card valid from (if applicable)	     	
Issue number (if applicable)	     	
Confirmation of amount to be taken	     	
Full address of cardholder

	     

I authorise payment by the method above.  Please register me for the Symposium

Signature ……………………………………………..    Date  ……………………………….