ESP 2007 Congress --- registration

Please fill in and submit this form. To facilitate communication you are kindly requested to fill as many fields as possible. Please take into account that the registration process will not proceed if at least the fields with an asterisk have not been filled. To move from field to field use the Tab Key or the mouse, NOT the Return key.

*Last (Family) name:

*First (Given) name:

Middle name:

Department:

Institution:

*Address:

*City:

*Country:

*Postal Code:

Phone:

Fax:

*E-mail:

Congress registration fees (in pound sterling = GBP)

Please check appropriate boxes

	Payments received
	Before 1 June 2007	Before 15 August 2007	On-site
ESP-Members	-	-	385
ESP-Members (Emerging Countries)	-	-	280
ESP-Members (Students)	-	-	175
Non-ESP-Members	-	-	500
Invited speaker/chairperson
Accompanying persons	£ 35 per person/s
Social Dinner Tuesday 4 September 2007	£46 per person/s

ASP members are entitled to pay the same reduced registration fees as ESP members (please include proof of ASP membership).

Registration dues may be paid by the following methods. Please check the one you intend to use:

Credit card

Please download and fill in Credit Card payments form, print and send it by mail to Helen Thame (full address below) or fax to: +44 1225 383408.
Please note the cards that can be accepted and ensure that you fill in all details and sign the form. You should ensure that you also fill in the on-line form for registration as appropriate.

Bank order

Please transfer the funds using the following bank details: Barclays Bank plc, 37 Milsom Street, Bath BA1 1DW. Account Name: University of Bath, Account Number: 00981303, sort code: 20-05-06, SWIFTBIC: BARC GB 22, IBAN: GB90 BARC 20050600981303.
You must ensure that the bank includes your name and address so that the source of the payment can be easily identified.
Also it is essential that "Activity SHN110" is clearly communicated on the transfer form to ensure that it gets to the correct place and it would help to add the identifier R. Tyrrell ESP Congress.
Please send a copy of the bank transfer to Helen Thame (address below).

Cheque

Cheques should be made payable to the "University of Bath" with "Activity SHN110" clearly marked on the back of the cheque and sent to Helen Thame.

All correspondence to:

Miss Helen Thame
PA to Prof. R. M. Tyrrell
Department of Pharmacy and Pharmacology
University of Bath
Bath BA2 7AY, UK
Fax: +44(0)1225 383408

Please contact us by e-mail (H.C.Thame@bath.ac.uk, R.M.Tyrrell@bath.ac.uk) if you have questions or by telephone (+44 1225 386850).

To register, please press Submit Form:

To clear the form and start over, please press Clear: