Please complete the following registration form for the RSC2013 conference at Lancaster University.

The items marked by an asterisk (*) are mandatory fields.

Personal Details

First Name* :
Surname* :
Badge Name^ :
Gender : Male Female

^ If a badge name is not supplied, then the first name and surname are supplied by default.


Contact Details

Address 1* :
Address 2 :
Address 3 :
Address 4 :
City* :
County :
Postcode* :
Country* :

E-mail Address* :
Telephone Number :

Affiliation

Affiliation* :
Year of Study* :
Research Interests* :
Do you have a valid NUS card?* : Yes No

Conference Contribution

Would you like to give a talk?* : Yes No
Would you like to give a poster?* : Yes No
Are you willing to chair a session?* : Yes No

Accommodation & Catering

Do you require accommodation?* : Yes No
Do you have any special accommodation requirements? :

Do you require a parking permit?* : Yes No

Are you vegetarian?* : Yes No
Do you have any special dietary requirements? :

Evening Entertainment

Monday

Are you attending the ATASS sponsored race night?* : Yes No

Tuesday

Which evening activity would you like to do?* :

Wednesday

Are you attending the conference dinner?* : Yes No
Starter† :
Main† :
Dessert† :

†Fields must be specified if attending the conference dinner.

Thursday

Are you attending the optional trip to Williamson park?* : Yes No