SEG KazKyr 2011 Registration by 2kU3D7YI

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									                             SEG / CERCAMS-15

                       Cu-Au Deposits of Central Asia

                 Registration & Payment Form
The form on the following page is for registration and payment.
Please complete and return the form page only by:

   1. Completing the document and Signing and return as a PDF to
      cercams@nhm.ac.uk

   2. Completing the document and Signing and Mailing to
        Reimar Seltmann, CERCAMS
        Department of Mineralogy
        The Natural History Museum
        Cromwell Road
        London SW7 5BD, United Kingdom

   3. Completing the document and Signing and Faxing to
      +44 (0)20 7942 6012

The deadline for registration is the 1st September 2011. However, due to
limited access capacity at hosting mines (Kumtor – 15, others – 35) there is a
strict policy “First comes, first served”, and early booking is recommended.

Receipts for payment will be provided upon request from NHM London.

All enquiries can be directed to cercams@nhm.ac.uk

For Kyrgyz visa support please contact: AYakubchuk@orsumetals.com
                                                                     SEG / CERCAMS-15
                                                                    Central Asia workshop
                                                                         Registration &
                                                                         Payment Form


Title
Name
Address


Postcode
Telephone
Email


Field Conference Fees

Standard
Full program with Taldybulak visit (17-27 Oct)                      £750
Alternative
Full program but instead Taldybulak with Kumtor visit (17-28 Oct)   £950

Tailored segments

Kazakh part only (Kazzinc & Kazakhmys deposits)                     £500
Kyrgyz part only (workshop and Taldybulak visit)                    £350
Kyrgyz part only (workshop and Kumtor visit)                        £550
Workshop (foreigners)                                               £100


                 PAYMENT BY VISA / MASTERCARD /AMEX / MAESTRO
                          Required at time of Registration

Card Holders Name as appears on Card
Billing Address


Post Code
Card Number
Start Date
Expiry Date
Security Number
Visa            Master card                 AMEX               Maestro          Switch

Total to be charged to the Card

Signature

Date

								
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