Intelligent Finance Visa Credit Card
Intelligent Finance Visa Credit Card document sample
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The 4th International Conference on Intelligent Environments IE08 21 – 22 July 2008; University of Washington, Seattle, USA Author Registration Form One form per person only (forms may be photocopied) REGISTRATION (Please complete in CAPITALS) Conditions of Booking Family Name _________________________________ Title (Mr, Mrs, Miss etc) _________ Application Forms should be completed First Name___________________________________ Job Title _____________________ and returned to the address below and must be accompanied with the correct payment. Attendance at the event will only Institution of Engineering and Technology Membership No ____________________________ be confirmed on receipt of the full payment. Name of Organisation (for name badge) __________________________________________ All Author registration forms should be received Address for Correspondence ___________________________________________________ no later than Friday, 16 May 2008 to ensure that your paper is not withdrawn from the ___________________________________________________________________________ conference. Cancellation In the event of cancellation after Town/City __________________________________________________________________ Friday, 16 May, no refund can be made. The Institution of Engineering and Technology Postcode ____________________________________ Country ______________________ reserves the right to cancel any event. In this case, the full fee will be refunded unless a mutually convenient transfer can be arranged. Contact Telephone ____________________________ Fax _________________________ Details of event changes or cancellations are available by phoning Email ______________________________________________________________________ +44 (0)1438 765 657 Name Substitutions are accepted at any time Do you have any dietary or other requirements? ____________________________________ by fax or email. Fax: +44 (0)1438 765659 How did you hear about this event? Email: email@example.com Flyer in Post Email Advert (Institution Publication) Advert (Other) The IET Website Other Delegates with Special Needs The Institution of Engineering and Technology aims to offer FEES AND CHARGES (Please complete the appropriate box) fully accessible events to all its delegates. Please help us to accommodate any individual The author rate registration fee includes having a maximum of two papers presented at the needs that you may have by attaching a note to conference, attendance at the sessions, a copy of the conference proceedings, refreshments, the registration form. We will contact you to lunch and attendance at the conference dinner. discuss this as necessary. Data Protection - The information that you provide Author’s presenting more than two papers must pay the additional paper fee. to the IET and its associated organisations will be used to ensure we provide you with products and AUTHOR REGISTRATION (On or before 16 May 2008) $ c services that best meet your needs. This may include the promotion of specific IET and Author Rate $415.00 associated organisations products and services by post and/or electronic means. By providing us with Additional Paper Fee $300.00 your email address and/or mobile telephone number you agree that we may contact you by Total Remittance electronic means. You can change this preference at any time by visiting www.theiet.org/my. The Institution of Engineering and Technology Paper Serial Number is not, as a body, responsible for the views or opinions expressed by individual authors or Presenting Author speakers. Paper Title Complete and return this form to: PAYMENT DETAILS The Institution of Engineering and Technology Payment must accompany this registration form. Registration will only be confirmed on receipt of Finance Department full payment. P O Box 96 Stevenage PLEASE NOTE: Payment via Purchase Order is not accepted Herts SG1 2SD, UK Fax: +44 (0)1438 765 659 Please indicate the method of payment: Cheque Credit Card BACS For all enquiries telephone Cheques should be made payable to “IET” and crossed. +44 (0)1438 765 648 or email firstname.lastname@example.org Credit Card Visa MasterCard AMEX Switch Issue No _____ Valid from ____/____ Card Number The Institution of Engineering and Technology Expiry Date M M Y Y CSC (Card Security Code) is registered as a Charity in England & Wales Last 3/4 digits on signature strip (no 211014) and Scotland (no SC038698) Name of Cardholder Full registered address of Cardholder (if different from above) ___________________________ _______________________________________________ Postcode ____________________ For office use only : Ref: 12404 Bank Transfers (BACS) can be made to Barclays Bank Plc, UK Bank, 1 Churchill Place, London, E14 F312359 5HP. USD Account no: 42221333 Sort code: 20-65-82 IBAN GB43BARC 2065 8242 2213 33. A copy of the Robotics & Mechatronics Network Draft must accompany this form. Delegates must be aware that the Institution is not responsible for any gains or losses as a result of fluctuations in the Exchange rate.