Registration Form - Humanities

'1662' in Historical and Ecumenical Perspective
28-30 August 2012
DELEGATE REGISTRATION FORM
(Please note that the booking deadline is 1st July 2012; after which point all bookings will
be subject to a late registration fee)
PERSONAL DETAILS:
Full Name (for conference badge): _____________________________________________________
Address:
________________________________________________________________________________
_________________________________________________________________________________
Telephone: ____________________________________ Email ______________________________
Institution:________________________________________________________________________
Dietary requirement: ________________________ Access requirements:______________________
FURTHER INFORMATION
For queries relating to registration and hospitality, please contact the College of Humanities
Conference Manager by phone on +44 (0) 1392 723289 or by email at [email protected]
Your completed booking and payment forms should be sent by post to: The College of Humanities
Conference Manager, Room 329 , Amory Building, Rennes Drive, University of Exeter, Exeter, EX4
4RJ.
1-SX-D-F82-121-USX11- A400-PWSX053
'1662' in Historical and Ecumenical Perspective
28-30 August 2012
FULL CONFERENCE FEE
Covers admittance to all presentations, buffets lunches and refreshments.
Standard
£135
Postgraduate
£105
DAY-DELEGATE CONFERENCE FEE
Covers admittance to presentations, buffets lunches and refreshments on day indicated
Tuesday– half day
Standard
£40
Postgraduate
£30
Wednesday – full day
Standard
£55
Postgraduate
£45
Thursday – half day
Standard
£40
Postgraduate
£30
ACCOMMODATION (single en-suite rooms at St Lukes)
B&B en-suite accommodation: Tuesday, 28 August 011
B&B en-suite accommodation: Wednesday, 29 August 011
£40
£40
EVENING MEALS
Tuesday, 28 August
Wednesday, 29 August
£25
£25
LATE FEE (if registering after 1st July 2012)
£10
Please add £2 surcharge if paying by credit card
£2
Total fees payable £________
PAYMENT ARRANGEMENTS: Payment must be made at time of registration
Receipt of payment will be sent to the address on the registration form unless otherwise stated.
My cheque is enclosed. Cheques must be made payable in pounds sterling to The University of
Exeter.
My debit/credit card details are enclosed (please fill in the Credit Card Authorisation Form). Please
note we cannot accept American Express and there is £2 surcharge if you pay by credit card.
1-SX-D-F82-121-USX11- A400-PWSX053
CREDIT/DEBIT CARD AUTHORISATION ONLY
Please note that the University would prefer payment by UK credit card (Mastercard or Visa) or UK
debit card (Maestro, Solo, Connect, Electron etc). Card payments over £1000.00 may be subject to
security questions by the card user.
Card Holders Name ____________________________________________
Card Number
Start Date ____________ Expiry Date _____________ Debit Card Issue No. (if applicable) ____
Security Number (last 3 digits of number on signature strip)
Cardholders Address _____________________________________________________________
_____________________________________________________________
Postcode
I authorise the University of Exeter to charge my credit/debit card with the amount of £
Signature of card holder _________________________________ Date: ____________________
Cardholder’s Telephone No. _____________________________________
Delegate Name ________________________________________________
Course/Conference Name __________________________________________________
Department ____________________________________________________
1-SX-D-F82-121-USX11- A400-PWSX053