IUISC REGISTRATION FORM

March 10^th – 12^th, 2004 – Ormonde Hotel, Kilkenny

REGISTRATION DETAILS

Only one delegate per form. Provide full names not initials

Surname___________________ First________________ Prof / Dr/Mr/Ms_______________

Name of University (as to appear on name badge)___________________________________

Department__________________________________________________________________

Address for correspondence_____________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Contact Numbers: Telephone_______________________________________________

Fax __________________ E-mail _______________________

Name of Accompanying person: ________________________________________________

(Non delegate only)

___________________________________________________________________________

REGISTRATION FEE

Delegate (link to be set up to elements of rate) €610.00

Accompanying Person (link to be set up to elements of rate) €210.00

TOTAL A: €_________________

___________________________________________________________________________

LUNCHEON ARRANGEMENTS

Please confirm your attendance at the opening and closing lunch.

Date Function Please tick if you will attend

Wed 10^th March Opening Lunch □

Friday 12^th March Closing Light Lunch □

DIETARY REQUIREMENTS

Dietary Requirements (please specify)____________________________________________

___________________________________________________________________________

___________________________________________________________________________

ACCOMMODATION

Accommodation has been reserved in the Ormonde Hotel, Kilkenny. Accommodation on March 10^th & 11^th is included in the registration fee. The rate for additional night(s) is €120.00 B&B single occupancy or €150.00 B&B double / twin occupancy, per night. If you wish to stay for additional night(s), please indicate to avail of the above rates:

Arrival Date ___/___/___ Departure Date ___/___/___ No. of Nights ___________

Special Requests____________________________________________________________________

Name of person(s) sharing_____________________________________________________________________

Type of Accommodation Tick as appropriate

□ Single Occupancy □ Twin Occupancy (two beds)

□ Double Occupancy □ Other (please specify) ____________________________

TOTAL B: €___________

___________________________________________________________________________

PAYMENT TOTAL A+B: €_______________

For institutional nominees, invoices will be sent to their institution. All other payments can be made by company cheque, Visa or Mastercard. Please make cheques payable to Conference Partners, 96 Haddington Road, Ballsbridge, Dublin 4.

Please note that reservations will not be confirmed until full payment has been received.

Please tick method of payment

□ Cheque □ Visa □ Mastercard □ Invoice My University / Institution

(Purchase Order number required)

Credit Card Numbers__________________________________ Exp. Date______________

PO Number __(Mandatory Field)__ Billing Contact_______________________________

Department__________________________________________________________________

Signature (if faxing)_________________________________ Date__________________

CANCELLATION POLICY

Cancellations received after February 11^th will not be refundable.

RETURNING THE FORM

Please complete and click SUBMIT to return to Conference Partners.

If you wish to send by fax, please fax to: 01 664 3701

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