IDA `97 Registration Form

IDA `97

Delegate Registration Form

(Please complete in block capitals)

Personal details

__________________________________     _______________________________     _________
Surname                                Firstname                           Title

____________________________________________________________________________________
Address

___________________________     _______________________     ________________________
City                            Post/ZIP code               Country

___________________________     _______________________     ________________________
Email                           Phone                       Fax

Memberships eligible for discounted rate:

AAAI  ACM  BCS  IEEE  SSAISB  

___________________________     _______________________
Organisation                    Membership number

Student discounted rate:

____________________________________     ___________________________________________
Institution                              Department

____________________________________     ___________________________________________
Name of Supervisor                       Signature of Supervisor

Registration fees

Figures are in UK pounds. Second figures are for credit card payments which carry a 3% surcharge. Please indicate appropriate rate.

                     Early            Late (after June 2nd 1997)

Standard             220/226.60 [ ]        270/278.10 [ ]

Standard (member)    200/206    [ ]        250/257.50 [ ]

Student              140/144.20 [ ]        175/180.25 [ ]

Student (member)     130/133.90 [ ]        165/169.95 [ ]

Accommodation at Canterbury Hall

Tariff includes breakfast. see http://www.dcs.bbk.ac.uk/ida97/canterbury.html

               Sunday August 3rd 1997  [ ]

               Monday August 4th 1997  [ ]

              Tuesday August 5th 1997  [ ]

            Wednesday August 6th 1997  [ ]

                 Number of nights  =

Tariff for Single room: 22/22.66 pounds per night

Accommodation total = Extra tickets for the Conference Dinner @ 40/41.20 each = TOTAL (registration + accommodation + extra tickets) = (NB: use higher figures if paying by credit card)

How to pay

1. By cheque drawn on a UK clearing bank

I enclose a cheque in pounds sterling payable to "Birkbeck College" in payment for IDA `97 registration and accommodation at Canterbury Hall as indicated above

Amount _____________________ Signed  _________________________    Date _____________

2. By Credit card (Visa/Access/Mastercard only)

I enclose my Visa/ Mastercard/Access details and the amount I wish to be credited to "Birkbeck College" account in payment for IDA `97 registration and accommodation at Canterbury Hall as indicated above

Name on card ________________________________________________

Cardholders
Address      _______________________________________________________________________


Card type  VISA              [ ]       Card Number _________________________________

           Mastercard/Access [ ]       Expiry date _____________

Amount (pounds sterling) ___________ (please use second figures from above)


Cardholders 
signature ________________________________    Date _____________

Please print out this form and send it to:

Mrs Betty Walters (IDA-97 Administrator)

Department of Computer Science

Birkbeck College

Malet Street

London WC1E 7HX

United Kingdom

or fax to Betty Walters on +44 171 631 6727

Please note that email credit card payments cannot be accepted

Cancellation Policy:

We should be notified in writing of all cancellations. Cancellations received before 1st July 1997 will incur a 20% administration charge. We cannot accept any cancellations after that date.