Registration Booking Form

Booking form can also be downloaded from the Kent Website

 

BOOKING FORM FOR REGISTRATION

The End Of…? Conference: Saturday 21^st and Sunday 22^nd January 2012

Please complete and return the following form to thendof2012@gmail.com by Wednesday 11^th January 2012. 

If paying by cheque, please complete and send enclosed the cheque to:

The End Of Conference

School of Arts

Jarman Building

University of Kent

Canterbury

CT2 7UG

United Kingdom

Cheques should also be received by Wednesday 11^th January 2012.  PLEASE NOTE: due to the Christmas holiday there will be no facility for receiving post between December 22nd 2011 and January 3rd 2012. 

1.      CONTACT DETAILS

Surname:
First Name:
Title:
Correspondence Address:
Tel:		Fax:
E-mail:
Affiliation if applicable: (University/Institution)

2. REGISTRATION

The registration fees below include attendance at all sessions, refreshments and lunches on both days (Day Two is included at no extra cost).     

The fee also includes entry into a special screening of 2001: A Space Odyssey with an introduction by Peter Krämer on Saturday 21^st January in the Gulbenkian Cinema (located on campus).   

Booking Rates	Full fee	Student
Registration Fee	£25.00	£15.00

3.      PAYMENT OPTIONS

Name:

Signature:

Please choose one of the following options below by ticking the appropriate box and inserting the relevant information:

A)   I would like to pay by Credit/Debit Card:

Card Type

Name on card:

Billing address:

Card Number

Start date:

Expiry date:

Issue number  (Switch):

3 digit security code* (Other Cards):

Total amount:

* This is the last three digits on the back of your card. You can send this separately from this form if you are concerned about data security: please email the code to thendof2012@gmail.com

B)    

I enclose a Cheque in £ sterling made payable to ‘University of Kent’

(Please see front sheet for postal details)

4. DIETARY AND OTHER REQUIREMENTS

All meals will include vegetarian options. Indicate here if you are vegetarian or detail more specialised requirements.
Please inform us if you have mobility or sensory impairments and give details of specific requirements.

5. TECHNICAL REQUIREMENTS (FOR SPEAKERS ONLY)

Do you require any special technical requirements (PowerPoint, DVD player, Internet access, etc.)?	YES	NO
If yes, please expand: