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Wordsworth Summer Conference 2009 Registration Form

Please print this form, complete the personal information, tick where applicable
in the right hand column, and mail it to the Conference Administrator:

Mrs. Fiona Gravil, Tirril Hall, Tirril, Penrith CA10 2JE, UK

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 (dinner B&B)  
The above accommodation is for Part 1 [the 5 nights of July 27-31]  
The above accommodation is for Part 2 [the 5 nights of August 1–5]  
The above accommodation is for Parts 1&2 [the 10 nights of July 27–August 5]            
I enclose my conference fee of £185 per person  
I enclose my half conference fee of £155 per person for Part 1 / Part 2  
I have paid my registration fee online by Google Checkout / by bank transfer  
I accept responsibility for any cancellation charges as a result of late or non-arrival  
Dietary requirements:  
Signed:

 

 

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