Registration €150 (will include lunch on both days and the conference dinner)

Title:
First Name:
Surname:
Position:
Department:
Institution:
Address:
City:
Country:
Postcode:
Telephone:
Fax:
Email:
Special Dietary Requirements:
Date:

Method of Payment:

I enclose a cheque made payable to the 'University of Ulster'

Please invoice to the following address (an official purchase order number must be provided here):

Please charge my credit card (Mastercard/Visa only):
 
Name on card:
 
Card Number:..
 
Home Address:
 
Postcode: ..
 
Card Type: ..
 
Expiry Date:

City: ...............

   
Any Additional Notes:
I agree to my
name
  institution
  e-mail address
 
appearing on a list of delegates

NB: If you do submit credit card details on-line HEAcademy-ICS and the
hosts of the conference cannot guarantee security of these details,
and take no responsibility for any misuse.



 
If you have printed out this form, please sign, date and send to the address below:
Signed..........................................

Date.............................................

Karen Fraser
HEAcademy-ICS
Faculty of Engineering
Room 16G28
University of Ulster
Shore Road
Newtownabbey
BT37 0QB

Fax: 028 9036 8206

Booking Conditions
1. Full payment must accompany all applications. Places are allocated strictly in order of receipt of payment.

2. Cancellations can be accepted only if received in writing not later than 25th October 2006. This will incur a €30charge for administrative costs. Substitutions can be made at any time.

3. The registration fee will cover lunch and refreshments.

4. The organisers reserve the right to make amendments to the programme without notice, if required.

If you have read and accept the conditions above then click 'Submit This Form' to post your form.