Please complete a separate form for each person attending the workshop

Title (please select)   Mr Mrs Ms Dr Prof    

First name (as preferred on badge)


Surname


Position


Institution


Telephone


Email


The fee is £200 or £175 if booked before 13 December 2011. (After this date a refund would only be available if the place can be filled.)

Method of payment:
Please invoice my institution       Order ref
Purchase orders should be raised to Loughborough University and sent to LISU - not SCONUL
Credit card. As this is not a secure site, please phone 01509 635680 with your card details .

Invoice to


Email address for invoice (if different from above)


Invoice address


Special dietary or other requirements


Any particular questions you would like to have answered, or areas you would like covered?