Booking form for dinners and audio visual
Please complete this form and mail or fax with the attached credit card form or sterling cheque
(payable to University of Leicester) to:
Prof. Nick Cull,
School of Historical Studies, University of Leicester,
Leicester, LE1 7RH UK,
Email: njc14@le.ac.uk,
Phone: +44 (0)116-252-2861;
Fax: +44 (0)116-252-5213.
The History of the Future: Visions from the Past - 16-19 July 2003
Conference Registration: £100 (or £50 student)
Conference Accommodation: £150
This includes four nights en suite bed and breakfast, and first night conference dinner. Single rooms only.
First Night Dinner Fee (for non-resident delegates only) £20
• Check to reserve place at first night dinner (16 July) .............
• Check to reserve place at last night dinner (19 July) .............
• Check to request vegetarian option: .............
TOTAL (£): ............
PLEASE SEND CHEQUE (UK FUNDS) PAYABLE TO UNIVERSITY OF LEICESTER OR
USE FORM BELOW THIS ONE FOR CREDIT CARD PAYMENTS.
Audio Visual requirements for conference presentation:...................................................................
(other than PAL/NTSC video which are standard in every room)
Name ......................................................................................
Preferred Title & Affiliation (if any) ......................................................................................
Preferred Address ......................................................................................
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Telephone ......................................................................................
Fax ......................................................................................
E-mail ......................................................................................
CREDIT CARD FORM
Charge my Visa…../ MasterCard….../ Visa Delta.……/ Solo……./ Switch…….
Card No. ………………………………………………………………..
Valid From …………………………/Exp. Date …………………………
AMOUNT …………………………
CARDHOLDER'S FULL NAME: …………………………
CARDHOLDER'S ADDRESS..................................................................
......................................................................................
......................................................................................
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CARDHOLDER'S SIGNATURE..................................................................
(I hereby authorise the above amount to be debited to my Credit/Debit Card)
Today’s Date …………………………….
(CLOSE WINDOW)