Wordsworth Summer Conference 2012 Registration Form

We have very few rooms available, so please consult the Tariff and contact us by email regarding possibilities
before completing this form. Then p
lease print this form, complete the personal information,
tick where applicable in the right hand column, and mail it to the Conference Administrator:

Stacey McDowell, Department of English, 3-5 Woodland Rd, Bristol University, BS8 1TB.

Name(s):

 

 
Affiliation(s) and Status:

 

 
Postal Address(es):

 

 

 
Email address(es):  
Telephone:  
Please add my/our contact details to the WSC address list  
I /we will attend the conference on a non-resident basis  
Please book me/us accommodation in price Band A, B, C, D (delete as applicable)  
Please book us an apartment for three people if available / or a family room for three  
Please book me a place at the Youth Hostel Full Board / Half Board (delete as applicable)  
The above accommodation is for Part 1 [the 5 nights of 30 July to 3 August]  
The above accommodation is for Part 2 [the 5 nights of 4 to 8 August]  
The above accommodation is for Parts 1&2 [the 10 nights of 30 July to 8 August]            
I enclose my conference fee of £235 per person  
I enclose my half conference fee of £185 per person  
I have paid my registration fee online by Google Checkout / I enclose a sterling cheque  
I accept responsibility for any cancellation charges as a result of late or non-arrival  
I accept the terms and conditions outlined in the prospectus  
Dietary requirements:  
Signed: