Origins 2004 Registration

Lancaster 22 -24 March 2005

First Name :

Last Name :

Address:

Institution :

E-mail :

Telephone number :

Conference registration fee £ 60:

Student Conference registration fee £ 30 :

I would like full board accommodation at the University of Lancaster

En-suite ('bathroom included') £ 65.50
En-suite Twin ('bathroom included') £ 130.00
Standard £ 58.50

I will arrange my own accommodation :

Arrival date :

Departure date :

Special Dietary Requirements:

Payment Method :
Payment Details

Bank Transfer
Credit Card (not American Express)
Cheque

Comments :

* Required Field