Conference Registration Form

The Geometry of Data Analysis

Monday, 19th July 2010

Department of Mathematics and Statistics

The Open University

 

Completed forms should be returned to:

Sarah Frain, Statistics Group Secretary

Department of Mathematics and Statistics

The Open University

Walton Hall

Milton Keynes, MK7 6AA

Fax: 01908 655515

E-mail: MCS-Statistics-Conferences@open.ac.uk

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If completing this form by hand in order to fax/post please use block capitals, alternatively please complete and e-mail to the above address.  Please complete one form per delegate.

The registration deadline is 9th July 2010

                                                                Delegate Contact Information

Title

 

Surname

First name

Affiliation/
Organisation

Postal Address

 

 

 

Postcode/Zip code

Country

Fax

Email

 

Tel

Preferred wording on name badge

 

Please indicate any special dietary or disability requirements

 

 

 

Do you wish to present a poster                            YES/NO

Title of Poster:

 

Short Abstract:

 

 

 

Conference Fee
The registration fee includes lunch and tea/coffee/biscuits at session breaks.

The registration fee is £30.00

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Cancellation Details:
Cancellation on or before 9th July 201009 full refund.
Cancellation after 9th July 2010 no refund given.
Cancellations must be made via email or in writing.

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Payment of Fees:
Method of payment (please select appropriate method):


 

Cheque drawn on a UK bank in pounds sterling, payable to "The Open University"

 

 


 

Invoice (Please supply address if different from above):

 

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Credit Card/Debit Card (delete as applicable)

Credit Card/Debit Card payment details:

Payment Method: Visa, MasterCard, Delta, Maestro etc (delete as applicable)

We cannot accept payment by Amex, Apex or Diners Club

Credit Card Number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Credit Card Start Date:

 

 

/

 

 

 

 

Credit Card Expiry Date:

 

 

/

 

 

 

 

Issue Number (applies to debit cards only)

 

 

 

 

 

 

 

Three Digit Security Number

 

 

 

 

 

Please debit my account with the following amount £…………..   reference Statistics Gowerfest II Conference 2010

Name of Card Holder:  …………………………………………


Signature:   ................................................................................      Date:      /     /

Is a receipt required?              Yes/No