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									                                Conference Registration Form
          Para leer a América Latina: Comics, Graphic Novels and Collective Memory

                                    Room 349, Level Three, Senate House
                        Institute for the Study of the Americas, University of London
                                            1 March, 10:00 – 18:00


 First name(s):                                                        Title (Prof, Dr, etc):
   Surname:
University, College or Company:
Address:                                                             Tel:
                                                                     Fax:
                        Post code:                                   Email*:
How did you hear about this event?:

* Please tick this box if you do not wish to receive emails about future events

Signed:                                                              Date:


Fee enclosed:                £15 (standard)

                             £10 (student/unwaged)



                          Please note that this fee includes lunch and refreshments


Method of payment:           Cheque enclosed
                             Cheques should be made payable to UNIVERSITY OF LONDON and sent
                             together with the registration form to Chloe Pieters, Institute for the Study of
                             the Americas, Senate House, Malet Street, WC1E 7HU

                              Charge my debit/credit card:
                                   Visa    Mastercard      Delta Switch / Maestro Solo
                                   Please note that we do not accept American Express

Card number:



Valid from (mm/yy):                Expiry date:             Issue number: Switch and Solo cards only



Name of issuing bank (on reverse of card):
Cardholder’s full name:
Cardholder’s signature:

Billing address (if different from above):


                                                                              Postcode:
          In case of query regarding payment, please ring Chloe Pieters on 020 7862 8853 or e-mail:
                                             chloe.pieters@sas.ac.uk
             For payment with Credit Cards, please sign and fax the form to: 020 7862 8886

								
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