Christine Padesky Master Class Booking form

Name

Title

First name

Surname

Address

Institution

Name of house, department or unit

Postcode

I'll enter this address manually

Contact details

Telephone number

Email address

* please only enter one email address

Requirements

Any dietary requirements?

Any other requirements/comments?

Conference name badge

Name

Institution

Payment

Ticket price

Students/UoD Staff Standard £200
Other Standard £250

Please provide a valid student I.D or UoD staff number if applicable for fee

How will you be paying?

Credit/debit card

Cheque

When you have registered for your place you will recieve the link to make payment online to the email address you have provided. Please note your place is not confirmed until payment has been recieved. You need to make payment immediately to secure the ticket price you have selected.

Cancellation policy: If cancellation is made before Thursday 4th April 2013 then a refund less 25% admin fee will be due. Any cancellations made after this date no refunds will be issued.

Information provided above (your full name, title, institution and email address) will be used to complete a list of delegates to be distributed at the event.

Please tick to give your permission to include this information