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):
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| Affiliation(s) and Status:
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| Postal
Address(es):
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| 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: | |
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Signed:
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