Wellington Congress 2010 Registration Form Thursday 8 July to Sunday 11 July 2010 Please complete this form and return it will full payment to the address overleaf by 11 June 2010. Please complete either the day delegate or residential package section and use one form per delegate. Please tick the relevant box for your preferred excursion on Friday afternoon. Title: Surname: First name(s): Preferred form of address (for badge): Address: Contact telephone number: Email: Dietary requirements: Mobility needs: Day delegates Price per Cost per day person Conference attendance £25 Thu Includes afternoon refreshments 8th Lunch £10 Evening meal £15 Conference attendance Includes morning refreshments, packed lunch and excursion £45 Fri Portsmouth Historic Dockyard □ or Stratfield Saye □ 9th Evening meal and entertainment £25 (Madding Crowd folk group) Conference attendance Sat £45 Includes lunch and refreshments 10th Conference dinner £35 Sun Conference attendance £25 11th Includes morning refreshments and lunch Total cost for conference Residential package Ordinary Ensuite Accommodation and breakfast in Highfield Hall of Cost per day room room Residence Conference attendance Thu Includes afternoon refreshments and evening £70 £80 8th meal Lunch £10 £10 Conference attendance Includes morning refreshments, packed lunch, Fri and excursion, evening meal and entertainment £90 £100 9th (Madding Crowd folk group) Portsmouth Historic Dockyard □ or Stratfield Saye □ Conference attendance Sat £90 £100 Includes lunch and refreshments 10th Conference dinner £35 £35 Sun Conference attendance (as day delegate) £25 11th Includes morning refreshments and lunch Total cost for conference PAYMENT PRO-FORMA Names of delegates: I/We enclose a cheque/banker's order made payable to the University of Southampton and drawn on a UK bank. All payment must be in £ Sterling. I/We wish to pay by Mastercard/Visa (Please state which) Please give the following information: Full card number: _______________________________ Expiry date of card: _____/_____ Three digit security number (on reverse of card) ____________________________________ Name and private address of card owner: __________________________________________ ___________________________________________________________________________ I authorise the University of Southampton to debit __________________________________ ________________________________________ (amount in words) from the above account. Signed: ____________________________________ Date: __________________________ Please return an original pro-forma rather than a copy to: Wellington 2010 Archives and Manuscripts, Hartley Library, University of Southampton, Highfield, Southampton SO17 1BJ. Should you be unable to attend, a substitute delegate is welcome at no extra charge. A refund of 60% may be made on cancellations prior to 31 March 2010, and of 40% on cancellations 1-30 April. Should you cancel after 1 May 2010, the full charges remain payable. The University carries insurance for public liability where the University is at fault, but not for loss or for damage to your personal belongings, nor for injury where the University is not at fault. All delegates must be registered in advance. Please note that formal registration only takes place after the receipt of the full fees. A formal letter of confirmation will be sent to you after receipt of the registration form and payment. If you have special dietary or physical needs, please let us know when booking. We look forward to welcoming you to Southampton in July 2010.