Registration form for the Futures in Reproduction Conference
Saturday 15 - Sunday 16 December 2012
Complete the form below to register for the Futures in Reproduction Conference. Please complete and submit a
separate form for each person registering to participate in the conference. One accompanying non
registering guest may be entered on your application form, please submit their details below too.
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 |
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| Title * |
Specify: |
| First name * |
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| Family name * |
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| Job title * |
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| Department |
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| Institution/Organisation/Company * |
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| Address 1 |
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| Address 2 |
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| Address 3 |
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| City * |
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| Postcode * |
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| Country * |
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| Telephone * |
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| Email Address * |
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| Please tick if you do not want your email address to appear in the delegate list. |
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| Dietary preference: |
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Do you have any other particular requirements?
e.g. hearing difficulty, mobility disability, etc.
Please specify:
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Conference Booking Details |
Registration Fee
Saturday 15 December and Sunday 16 December 2012
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The conference registration fee includes attendance at the full two-day conference programme, a souvenir
programme, refreshment breaks, lunches on Saturday 15 and Sunday 16 December and receptions on Friday 14 and
Sunday 16 December.
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£175.00
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Accommodation Options
Option One - en suite accommodation |
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| Three nights single en suite accommodation at Churchill College on 14, 15 and 16 December.
Includes breakfast on Saturday 15, Sunday 16 and Monday 17 December and dinner on Friday 14 and Sunday 16
December
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£250.00
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Option Two - non en suite accommodation
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| Three nights single non en suite (shared bathroom) accommodation at Churchill College on 14, 15
and 16 December. Includes breakfast on Saturday 15, Sunday 16 and Monday 17 December and dinner on Friday 14
and Sunday 16 December.
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£200.00
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Option Three - Twin en suite accommodation
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| Three nights twin en suite accommodation at Churchill College on 14, 15 and 16 December.
Includes two breakfasts on Saturday 15, Sunday 16 and Monday 17 December and two dinners on Friday 14 and
Sunday 16 December.
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£375.00
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Conference Banquet
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| A conference banquet to be held in the Great Hall on Saturday 15 December at St John’s College.
This will include welcome
drinks, a four course dinner with wine and port and accompanying music. Transport by coach will be provided
from Churchill College to St John’s College and back.
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£75.00
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Other Booking Options
For those not staying at the accommodation or attending the Conference banquet. Dinner at Churchill College on
Friday 14, Saturday
15 or Sunday 16.
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| Dinner on Friday 14 December |
£30.00
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| Dinner on Saturday 15 December |
£30.00
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| Dinner on Sunday 16 December |
£30.00
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Accompanying Guest
To attend receptions and receive a copy of the conference programme
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If you are bringing an accompanying guest, please register them here if they wish to attend the
evening
receptions on Friday 14 and Sunday 16 December, lunch on Saturday 15 and Sunday 16 December and receive a
copy of the conference programme.
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£85.00
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To attend the conference banquet
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If you are bringing an accompanying guest, please register them here if they wish to attend the
conference banquet to be held in the Great Hall on Saturday 15 December at St John’s College. This will include
welcome drinks, a four course dinner with wine and port and accompanying music. Transport by coach will be
provided from Churchill College to St John’s College and back.
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£75.00
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Complimentary Tour |
Please note the tour of Bourn Hall is now full. |
Optional tour to Bourn Hall Clinic on Friday 14 December. A coach will be provided and will leave Churchill
College at 14.30. Places are limited and will be allocated in the order in which registrations are
received.
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Payment Information
All participants, including those from overseas, must pay the costs in British pounds sterling.
Payment may be made by cheque, international transfer, BACS, credit card or invoice.
A VAT invoice will be issued on registration. VAT reg no. 572 9262 18
Please indicate how you wish to pay
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I wish to be invoiced.
Please complete the invoice form below. To save time,
you can click the checkbox to copy your details if they are
the same as your registration details.
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I wish to pay by credit card through Paypal.
*Please note Paypal will add a fee of 3.4% for using their facility to your total amount.
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I wish to pay by International transfers or BACS payments. Please pay into:
Account name: Jill Rogers Associates Limited Client Account
Bank: Royal Bank of Scotland
Account no: 11335539
Sort code: 16-15-19
IBAN code: GB02RBOS16151911335539
Swift/BIC code: RBOSGB2L
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I wish to pay by cheque.
I will forward the cheque to you together with a printed copy of my email registration form
acknowledgement. Please make cheques payable to Jill Rogers Associates Client
Account and send it to:
Futures in Reproduction Conference, Jill Rogers Associates, 6 The Maltings, Millfield, Cottenham, Cambridge,
CB24 8RE
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