www.cambridgecnt.org
REGISTRATION FORM
International Forum on Carbon Nanoscience
St John’s College, Cambridge, UK, 13th November 2009
Please note that registrations will only be complete after full payment REGISTRATION DEADLINE: 30 Sep 2009
th
Title (Prof/Dr/Mr/Ms etc.): Surname*: First Name*: Organization*:
Department: Street: City/Town*: Post Code: Country*: Telephone: Fax: E-Mail*: Optional comments:
* indicates a required field
DATA PROTECTION STATEMENTS Personal data as supplied by delegates will only be used for the purpose of administering this meeting and for publicity for future Cambridge CNT symposia, and for the production of a register of attendees for distribution to delegates. Please tick this box if you wish your name, affiliation, and email address to be included in the list of attendees given to delegates at the meeting. (Double click on check box to change its value.)
Page 1 of 3
REGISTRATION FEES CambridgeCNT Symposium 09
REGISTRATION * FULL REGISTRATION STUDENT REGISTRATION # INDUSTRIAL REGISTRATION £60 £20 £150
Please tick Double click on the check box to change its value.
* Registration includes lunch, coffee and tea. # Student rate applies to those registered for a higher degree.
PAYMENT DETAILS:
Payment should be made in Sterling through one of the following options (please tick your preferred option; double click on the check box to change its value). (1) PayPal Click on this link http://access.cambridgecnt.org/register.html and follow the instruction. (2) Bank transfer * Bank Name: HSBC (Cambridge Branch) Account Holder: Cambridge CNT Society Account Number: 62787474 Sort Code: 40-16-08 IBAN: GB03 MIDL 401608 62787474 BIC: MIDLGB2103J
* Please note that when payment is made by bank transfer. The bank transference expenses should be paid by the issuer and a copy of the bank remittance slip should be sent to the Registration Officer, in order to validate the registration. Registration is only complete after we have received payment. You should receive an e-mail acknowledgement after payment is received. If you do not receive such an acknowledgement, please contact the symposium organisers on committee@cambridgecnt.org
Date: .................................... Name: ......................................................
Please email the completed form to:
Cambridge CNT Society c/o Registration officer Email: registration@cambridgecnt.org
Page 2 of 3
ABSTRACT
If you would like to submit an abstract for a poster presentation, please write your abstract below [~200 words]: Title: Authors: Affiliation: Abstract:
The 3rd Cambridge CNT Symposium 2009 is organised by Tobias Wirth (Chair), YanYan (Shery) Huang (Co-Chair), Rose Spear, Krzysztof Koziol, James McGregor, Juan Vilatela, Yan Zhang, Bernhard Bayer, Santiago Esconjauregui, Sai Giridhar
Page 3 of 3