Booking Form

Delegate
Surname* First Name(s)*
Title Nationality
Institution Position
Postal Address
Phone (work) Phone (home)
Fax E-Mail*
Special Requirements Questions
Type of Registration*
(see below for more information on each)

Earlybird Full Registration
Full Registration
Late Registration
Day Delegate 27/1/2005
Day Delegate 28/1/2005
Dinner Only
Discounted student places (limited number)

Purchase order number (if applicable)
EAIR members are entitled to a 10% discount, when booking early.
I am an EAIR member
* denotes required fields

Our Fax number is 0114 2255186.
Make all cheques payable to Quality Research International.

Registration Fee
Earlybird full registration (2 days with one night accommodation) including gala dinner (before 1 September 2004) £375
Full registration (2 days with one night accommodation) including gala dinner (before 1 November 2004) £450
Late full registration (after 1 November 2004) £495
Day Delegate 27/1/2005 (before 1 November) £195
Day Delegate 28/1/2005 (before 1 November) £195
Day Delegate 27/1/2005 (from 1 November) £250
Day Delegate 28/1/2005 (from 1 November) £250
Dinner Only £50
Discounted student places (limited number) £225



Payment
Invoice my Institution
Full details of position and the address of your Institution along with purchase order number (where appropriate) must be furnished. The payment must be completed before the conference.

Cancellations:
Before 1 September 2004 refund of 75%
Between 1 September 2004 and 31st October 2004 refund of 50%
Between 1st November 2004 and 10th January 2005 refund of 25%
No refunds after 10th January 2005.

Payment by Direct Remittance
Please print a copy.