Online Conference Registration Form
By filling out this form you will be included in the Mental Health in Higher Education (mhhe) project database which is kept in accordance with the Data Protection Act principles & requirements.
You can download a hard copy of this registration form as a Excel 2007 file or a PDF file. Hard copies should be returned to: Ros Malcolm, Conference Coordinator, Conference Centre, Bowland Avenue East, Lancaster University, Ellel, Lancaster, Lancashire, LA1 4YT , or to r.malcolm@lancaster.ac.uk. Cheques should be made payable to ‘Lancaster University’.
Surname
Forename
Title
Job Title (if applicable)
Institutional Affiliation (if applicable)
Contact Address Line 1
Address Line 2
Town/City
County/Province
Postcode
Country
Is this your home/work address?
Contact telephone number
E-mail address
I am happy for my email to be included in the delegate list.
Please note the conference registration fee includes lunches & refreshments only — for conference dinner & accommodation see below
Early Bird (available until 22/01/2010) - £190.00 Full Rate (after 22/01/2010) - £220.00 Concessionary Rate (student/unemployed) - £155.00
I am a speaker
I have applied for a Bursary
Please indicate your accommodation requirements below (rates are for B&B, all rooms are ensuite):-
No accommodation required
Tuesday (30/03/2010) £45.10
Additional nights at £45.10 per night: Monday (29/03/2010), Wednesday (31/03/2010)
Please tick this box if you require a bedroom on the ground floor
Tuesday (30/03/2010) £18.50
Special Dietary Requirements...
If there is any other information (e.g. About access needs) that you think may be relevant to your attendance of the conference, please supply full details:
Additional Relevant Information...
Any cancellations made after 22/01/2010 will not normally be eligible for a refund.