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Registration form Society for Industrial and Applied Mathematics Conference on Nonlinear Waves and Coherent Structures Monday 11 – Thursday 14 August 2014 Churchill College, University of Cambridge, CB3 0DS, UK Complete the form below to register to attend the conference. Please complete and submit a separate form for each person registering. Once you have submitted your completed form you will receive an immediate email acknowledgement of your online registration. This will be followed by confirmation of your registration details within 5 working days. If you have not heard from us within this time please contact us again.
Delegate details
* - Required fields
Title *	Specify:
First name *
Family name *
Job title *
Department
Institution/Organisation *
Address 1
Address 2
Address 3
City *
County
Postcode *
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Telephone *
Email Address *
Are happy for your email to appear in the delegate list *	Yes No
Please indicate your role/s at the conference	Contributed Speaker Minisymposium Organizer Minisymposium Speaker Poster Presenter Not Presenting
Please select your affiliation	Academia Industry Government Laboratory Other, please specify
Emergency contact name *
Emergency contact email *
Emergency contact telephone *
Dietary preference
Do you have any other particular requirements? e.g. hearing difficulty, mobility disability, etc. Please specify
In an effort to protect our environment by producing less printed material, we offer you this option when you collect your registration materials onsite*	I will not collect a printed program I prefer to collect a printed programme
Payee details
Same as above, if no then please complete this section.*	Yes No
Title	Specify:
First name
Family name
Job title
Department
Institution/Organisation
Telephone
Email Address

Conference booking options and fees Please note: Cancellations received before 14 July 2014 will be refunded, less an administration fee of 20%
Conference attendance Monday 11 August to Thursday 14 August 2014 For accommodation and catering options, see details below. Fee covers attendance to conference with morning and afternoon tea, coffee and biscuits each day.
For bookings made after 14 July 2014
SIAG/NLW Member	£275.00
SIAM Member	£280.00
Non-member	£360.00
Non-member, Mini-speaker or Organizer Participant	£320.00
One Day	£180.00
Student	£100.00
Accommodation situated at Churchill College for a single room Includes bed and breakfast. Non en-suite rooms share bathroom facilities and are all fitted with wash hand basins. En-suite rooms have their own bathroom facilities.
Saturday 9 August (non en-suite room)	£51.50

Sunday 10 August (non en-suite room)	£51.50

Monday 11 August (non en-suite room)	£51.50

Tuesday 12 August (non en-suite room)	£51.50

Wednesday 13 August (non en-suite room)	£51.50

Thursday 14 August (non en-suite room)	£51.50

Friday 15 August (non en-suite room)	£51.50

Saturday 16 August (non en-suite room)	£51.50
There are a number of twin rooms available at Churchill Conference on a first come, first served basis. If you wish to book a twin room please contact the conference office: [email protected] Full details about the accommodation at Churchill College, as well as information about other accommodation options, is available on the SIAM website pages for this conference.

Catering Catering situated at Churchill College. Lunches Please indicate if you would like to book lunch for the following dates:
Lunch on Monday 11th August Includes a finger buffet	£12.50
Lunch on Tuesday 12th August Includes a finger buffet	£12.50
Lunch on Wednesday 13th August Includes a finger buffet	£12.50
Lunch on Thursday 14th August Includes a finger buffet	£12.50
Evening Meals Please indicate if you would like to book an evening meal for the following dates:
Dinner on Monday 11th August Includes a hot/cold buffet	£22.00
Dinner on Tuesday 12th August Includes a hot/cold buffet	£22.00
Dinner on Wednesday 13th August Includes a hot/cold buffet	£22.00
Dinner on Thursday 14th August Includes a hot/cold buffet	£22.00

	Total: £ (Incl. VAT@0%: £)

Additional Sessions
Reception and Poster session Please indicate if you wish to attend the Reception and Poster session Tuesday 12th August	I wish to attend
Business meeting (open to SIAG/NWCS members) Please indicate if you wish to attend the Business meeting Wednesday 13th August	I wish to attend
Payment Information All participants, including those from overseas, must pay the costs in British pounds sterling. Payment is required at the time of booking where you will be transferred to Paypal to complete your payment when you click the submit button below. Please note Paypal will add a fee of 3.4% to your total amount for using their facility, this will be shown as postage and packing.
I wish to pay by credit card or debit card through Paypal. *Please note Paypal will add a fee of 3.4% for using their facility to your total amount, this will be shown as postage and packing.

I have read and accept the Terms and Conditions*
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Please note:
When you submit this completed form the current web page will close and a new page will open confirming that your registration has been sent. You will also receive an immediate email acknowledgement of your registration. If this DOES NOT happen your registration has not been successful and you should complete the form again. If you have not heard from us within 5 working days please contact us again.

Registration form

Delegate details

Payee details

Conference booking options and fees

Additional Sessions

Payment Information

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