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4th International Palaeoflood Workshop Chania, Crete Sunday June 24th - Saturday June 30th 2007 Registration Form. All delegates must pre-register. A late registration surcharge of 15% will apply to all applications received on or after March 1st 2007 (see Section 5). Registration closes on April 1st 2007. Please complete one form (Sections 1-4) for each delegate (the names of accompanying persons can be entered in Section 2). Please mail, email or fax completed forms to: Dr Paul Brewer Institute of Geography and Earth Sciences University of Wales Aberystwyth ABERYSTWYTH Ceredigion SY23 3DB, UK Fax: +44 (0) 1970 622659 email: email@example.com 1. DELEGATE INFORMATION Please fill in all of the fields (* fields used for name badges). Title: Department: University or organisation*: Full postal address: Forename*: Surname*: Telephone: Fax: e-mail: I require vegetarian meals (please tick if appropriate) I have the following dietary requirements: Other information: 1 2. BOOKING FORM A) WORKSHOP (Sunday 24th June – Wednesday 27th June 2007) The all-in-one cost for delegates and accompanying persons includes: Workshop registration (not for accompanying persons) „ice-breaker‟ on Sunday 24th 4 nights B&B accommodation at MAICh conference centre (Sunday-Wednesday) Morning & afternoon refreshments, lunches and evening meals on Monday 25th and Wednesday 27th Fieldtrip to Samaria Gorge (including a packed lunch) followed by the conference banquet on Tuesday 26th Please tick one box i) Delegate registration + accommodation in a single room ii) Delegate registration + accommodation in a twin (bunk) room iii) Delegate registration + accommodation in an attic (twin + single) room iv) Accompanying person + accommodation in a twin (bunk) room v) Accompanying person + accommodation in an attic (twin + single) room £440 £370 £380 £190 £210 For twin or attic rooms, please indicate who you would prefer to share the room with: Name(s): B) POST-WORKSHOP FIELDTRIP (Thursday 28th June – Saturday 30th June 2007). The all-in-one cost for delegates and accompanying persons includes: 2 nights accommodation at Keratokambos (including breakfasts and evening meals) Packed lunches on Thursday 28th and Friday 29th June Taverna lunch on Saturday 20th June The price DOES NOT INCLUDE accommodation on the night of Saturday 20th June Please tick one box i) Accommodation in a single room (limited number available) ii) Accommodation in a twin room iii) Accommodation in an triple room For twin or triple rooms, please indicate who you would prefer to share the room with: Name(s): £250 £210 £200 C) SUB-TOTAL (A+B) D) LATE REGISTRATION FEE (15% of sub-total) (applicable to all workshop and post-workshop fieldtrip bookings made on or after 1st March 2007) £ £ E) TOTAL AMOUNT PAYABLE (C+D) £ 2 3. PAYMENT There are four payment options as detailed below. Confirmation will be sent to you upon receipt of payment, but please do not expect a response for 14 days. Payments received on or after March 1st 2007 will incur the late registration surcharge. Please note that registration closes on April 1st 2007. Please contact Dr Paul Brewer firstname.lastname@example.org if you are at all concerned about the processing of your payment. a) Pay by cheque, bankers draft or money order made out to “UWA”. Please send directly to Dr Paul Brewer at the address on page 1 of this registration form I have enclosed a cheque (in pounds Sterling drawn on a UK bank) I have enclosed a Sterling bankers draft I have enclosed an international money order b) BACS payment - international money transfer I am paying by an international money transfer Please transfer money to the following account quoting reference number “4thIPW” Bank HSBC PLC 19 Great Darkgate Street PO Box 12 Aberystwyth Ceredigion SY23 1DH 40-08-09 Sort Code Account name/No. UWA General Account / 01197339 IBAN number GB41MIDL40080901197339 c) Pay against an invoice. Please note that to avoid the late-registration surcharge all invoices must be settled in advance of April 1st 2007 Please send me an invoice for the above total amount, quoting the following official order number: 3 d) Pay by credit or debit card I am paying by credit or debit card Please complete the form below or provide the details directly to Jackie Hedley (UWA Finance Office) by telephoning + 44 (0) 1970 622040 (Prior to telephoning Jackie Hedley, please send a copy of your registration form to Paul Brewer) Visa / Mastercard / Delta / Switch / American Express (please delete as appropriate) NB there is a 3.5% surcharge for payment by American Express Card number: / / / Security Code (the final three digits of the number printed on the signature strip) : If you prefer, you can email this code to email@example.com Issue Number (if indicated): Valid from: / Cardholders name (as printed on the card): Billing address Expiry date: / Signature of the cardholder: ………………………………………………………………. 4. CANCELLATION & REFUNDS Cancellations on or before March 1st 2007 Cancellations on or before April 1st 2007 Cancellations on or before June 1 st 2007 Cancellations after June 1st 2007 Full refund 90% refund 50% refund No refund 4 5. INSURANCE DECLARATION This form MUST BE COMPLETED AND SIGNED by all delegates/accompanying persons who intend to go on the mid-workshop Samaria Gorge fieldtrip and/or the post-workshop Anapodaris fieldtrip. The University of Wales, Aberystwyth, as Organisers of the 4th International Palaeoflood Workshop, Chania, Crete, draw the attention of workshop delegates and accompanying persons to the fact that the planned mid-workshop fieldtrip to the Samaria Gorge, and the post-workshop fieldtrip to the Anapodaris Gorge, may present physical difficulties for some attendees. The nature of the terrain is demanding and there is inevitably some risk of physical injury. The Organisers therefore require workshop delegates and acc ompanying persons who wish to be included in one, or both, of the fieldtrips to warrant that they will obtain appropriate and adequate insurance cover prior to embarking on such fieldtrips and that they sign the declaration below. DECLARATION I, of (Workshop delegate) (Address) I, of (Accompanying person) (Address) declare that in consideration of my being included as a member of the party undertaking a fieldtrip to either of the above locations, or to any substituted locations, I shall obtain, at my own cost, all appropriate and adequate insurance covers and that inclusion in the party undertaking either or both of the fieldtrips is entirely at my own risk. Signed__________________________________ (workshop delegate) Signed__________________________________ (accompanying person) Dated____________ _______2006/7 5
"4th International Palaeoflood Workshop"