15th ANNUAL EHF MEETING Woodland Grange - Leamington Spa 13th & 14th 2018 REGISTRATION : (Please type or print) Title: First Name: Family Name: Position: Organisation: Department: Mailing Address: Post Code: E-mail: Country: Phone: Fax: Do you have any kind of disability? No Yes Please specify:   Do you have any special dietary requirements? No Yes Please specify:   & Meeting Requirements: Full meeting (includes £410.00  the conference dinner and Tuesday night accommodation) £100.00 Accommodation night (Monday)  – Tuesday £135.00  Day delegate Wednesday £135.00  Conference Dinner £55.00  Workshop Places are limited and workshops require an application form & meeting registration No extra fee but meeting registration required Basic Pathology and Cell Recognition (Tuesday)  Total £ To comply with the Data Protection Act, please indicate your consent for your details to be kept for use by the EHF I DO* / DO NOT* CONSENT Signed: Date: ……………………… ……………… *delete as required  Please tick here if you DO NOT want your details to be passed on to the trade companies present at the meeting. Please return the completed form to: A. Southgate, Northwick Park Events, NPIMR, Y Block, Northwick Park Hospital, Harrow, Middlesex. HA1 3UJ Tel: +44 (0)20 8869 3648 Fax: +44 (0)20 8869 3270 e-mail:A.Southgate@ic.ac.uk Payment is possible by: cheque (payable to Northwick Park Events) in POUNDS STERLING, drawn on a UK BANK, BACS Barclays:- Account name: Northwick Park Events. 83908747 Account number: Sort code: 20-37-21 BIC: BARCGB22 IBAN: GB48 BARC 2037 2183 9087 47
15th ANNUAL EHF MEETING Woodland Grange - Leamington Spa 13th & 14th 2018 REGISTRATION : (Please type or print) Title: First Name: Family Name: Position: Organisation: Department: Mailing Address: Post Code: E-mail: Country: Phone: Fax: Do you have any kind of disability? No  Yes  Please specify: Do you have any special dietary requirements? No  Yes  Please specify: & Meeting Requirements: Full meeting (includes the conference dinner and Tuesday night accommodation) £410.00  Accommodation – night (Monday) £100.00  Day delegate Tuesday £135.00  Wednesday £135.00  Conference Dinner £55.00  Workshop Places are limited and workshops require an application form & meeting registration Basic Pathology and Cell Recognition (Tuesday) No extra fee but meeting registration required  Total £ To comply with the Data Protection Act, please indicate your consent for your details to be kept for use by the EHF I DO* / DO NOT* CONSENT Signed: ……………………… Date: ……………… *delete as required Please tick here  if you DO NOT want your details to be passed on to the trade companies present at the meeting. Please return the completed form to: A. Southgate, Northwick Park Events, NPIMR, Y Block, Northwick Park Hospital, Harrow, Middlesex. HA1 3UJ Tel: +44 (0)20 8869 3648 Fax: +44 (0)20 8869 3270 e-mail:A.Southgate@ic.ac.uk Payment is possible by: cheque (payable to Northwick Park Events) in POUNDS STERLING, drawn on a UK BANK, BACS Barclays:- Account name: Northwick Park Events. Account number: 83908747 Sort code: 20-37-21 BIC: BARCGB22 IBAN: GB48 BARC 2037 2183 9087 47
EHF_2018_-_delegate_registration_form.docx