Delegate Registration Form - Delegate Registration Booking Form.doc

					Disability History: looking forward to a better past?
June 25th - 26th, 2010



Delegate Registration Booking Form
To register and book a place at the conference please complete all fields and provide details as you wish them to
appear in delegate documentation and return to:
Emma Kelly, Conference Officer, Conference and Events Management, University of Central Lancashire,
Foster Building Room 10, Preston PR1 2HE, UK
Phone: +44 (0)1772 892654 Fax: +44 (0)1772 892977 E-mail: eakelly1@uclan.ac.uk

Please note that important notes about completing this form and the terms and conditions which
apply are set out at the end of this form. Please read these before completing the form. By submitting
your booking form you are confirming that you accept these terms and conditions. Please note that
we reserve the right, in our absolute discretion, to refuse your application to attend the conference
and that your place at the conference is subject to confirmation from us in writing that your booking
form has been accepted.


Section 1:

Title:                 Forename:                                        Surname:
Position:
Company/Organisation/Institution:
Address:
City:                                 Postal code:       Country:
Tel:                                  Fax:               (Please indicate if you would not like this to appear in the delegate pack)
                                                         E-mail:

I consent to my email address being given to conference delegates:                  yes        no

Please see data protection statement below.


Section 2: Conference Fee (inc vat)

Accommodation is only included in the full conference fee, this will be reserved at The Legacy Hotel,
Marsh Lane, Preston. Due to limited numbers of rooms once they have been allocated we can advise
you of other accommodation in the area that you can directly book yourself, but these rates may be
higher.

***Refreshments and lunch are included in all the conference fees***

Please tick choice:

   Rate one - Full conference with one night B+B accommodation : £250
   Rate two - Full conference (no accommodation) : £185
   Rate three - Friday or Saturday only (no accommodation) : £95

Discounts are offered for students (£20) and Disability History Group members (£15) on all the above fees.
Please tick below if you wish to claim these discounts
   Student (undergraduate or post-graduate)
   DHG member




Disability History Conference 2010 – Registration form
Disability History: looking forward to a better past?
June 25th - 26th, 2010


Section 3:
To help us to ensure that all delegates are able to participate fully, please let us know about any
requirements you have (e.g. access/dietary)



Section 4: Payment Method

   By Cheque: Cheques should be in Sterling and made payable to ‘UCLan Business Services Ltd.’

   By Invoice: I enclose a purchase order/letter from my organisation and wish to be invoiced (UK delegates
    only)
   By Credit/Debit Card: Please charge my Visa/Maestro* card with the total amount shown here:
   ……………………………………………………………… Type of Card: ………………………………………..

    Card No.:…………………………………………………. Name of card holder:…………………………………

    Valid from date: mm / yy                 Expiry date: mm / yy         Issue no:

    Signature of card holder: .........................................   Date: ……………………………………………………

    Address of card holder: …………………………………………………………………………………………….

We will issue you with a receipt once payment has been taken. Please note that, save as set out in the Terms
and Conditions below, charges are non-refundable.


Section 5: Evaluation

At the end of the conference, you will be asked to complete an evaluation form. To ensure we maintain a high
quality of service, we welcome your comments and suggestions and would ask that you take the time to
complete these details and return them to us.


IMPORTANT NOTES ABOUT COMPLETING THIS FORM

Section 1
   1. Please ensure that if completing by hand you use BLOCK letters.
   2. Your name and organisation/place of study as stated on this form will be used for your badge and the
       delegate list.
   3. Please provide your full postal address including the name of your organisation/workplace.
Section 2
   1. Please ensure you tick the appropriate fee box for the registration category you are applying for.
Section 3
   1. Please ensure that you complete this section for any dietary, access, hearing or mobility requirements
       you may have.
   2. Special Diets. All catering is organised with options to fulfil the requirements of vegetarians.
       However, if you have a special diet, please indicate this on the booking form. We will confirm if this
       cannot be catered for.
Section 4
   1. Please note that we cannot accept payments by Diners Club and American Express or by BACS
       transfer.
   2. If you require an invoice please complete the details in full and always include a purchase order
       number. We can not issue an invoice without this.




Disability History Conference 2010 – Registration form
Disability History: looking forward to a better past?
June 25th - 26th, 2010


IMPORTANT INFORMATION
                                                         th   th
Disability History Conference 2010, 25 – 26 June 2010

Conference Fee - The cost of the conference fee includes lunches and refreshments, conference
accommodation is only included in rate one.


TERMS AND CONDITIONS

    1. Registration/Payment Terms - By returning this form you are requesting a firm booking.
       Please note that your place at the Conference is subject to confirmation from UCLan in writing
       that your application is accepted. We reserve the right in our absolute discretion to refuse
                                                                                     th
       your application to attend the conference. All forms must be received by 28 May 2010. Bookings
       will be accepted and confirmed only when full payment or invoicing instructions have been received.
       Bookings will not be accepted unless they are made using this official form. Payment sent
       independently of this booking form must state details of the delegate and the conference. If you do
       not receive a confirmation e-mail of your booking within two weeks of the conference, please contact
       the Conference Office.
                                                                                    th
    2. Cancellation Policy – Any cancellations received up to and including [28 May 2010] will be given a
       full refund. For cancellations received after this date, a refund will not be given. Cancellations
       must be made in writing to eakelly1@uclan.ac.uk Verbal cancellations will not be accepted.

    3. Substitutions Policy – Requests for named substitutions (subject to our right of refusal) are
                             th
       accepted up to [28 May 2010] and should be made in writing to eakelly1@uclan.ac.uk Verbal
       substitutions will not be accepted. Packages cannot be shared under any circumstances.

    4. Booking Acknowledgment and Information - Please note that your booking acknowledgement will
       be sent once the form has been received. Formal joining instructions will be sent to you via email
       approximately two weeks before the start of the conference.

    5. Data Protection - UCLan will hold, use and process personal information to assist it in carrying out
       organisation of the conference at which you have requested a place. We will also use the details on
       your booking form in order to inform you of future conferences we have organised which might be of
       interest to you unless you request us not to do so by ticking the box below.

          No

          UCLan will comply with its obligations under data protection legislation. Please refer to UCLan’s Data
          Protection Policy (available at www.uclan.ac.uk or by post on request) for further information.

    6. General - If any provision of these Conditions is found to be invalid or unenforceable, the remainder
       shall not be affected. Any waiver by us of any breach by you is not a waiver of any other or
       subsequent breach. These Conditions and the contract between us do not create, confer or purport to
       confer any benefit or right enforceable by any person not a party to it.

    7. English Law – These Conditions and the contract between us are subject to English law and the
       exclusive jurisdiction of the English courts.




Disability History Conference 2010 – Registration form

				
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