WoTUG 22 Registration Form

   Name:
   
   Name as you'd like it to appear on your name badge (if different):

   Organisation:
   Address:





   Post code / ZIP code:
   Telephone:
   Fax:
   Email:

   Fee in Sterling (free of VAT) : tick as appropriate
   ___ Full fee of GBP 295.00
   ___ Fee with student bursary of GBP 195.00 (___ approval reference number)
   ___ Extra night's accommodation on Saturday 10th (GBP 19.00)?

   Sex (Male/Female):

   Please indicate any dietary or other requirements:



   Payment by CHEQUE:

      Cheques must be in Sterling and made out to "Keele University"

      Send this form, with your cheque, to:
	Kendal Allen,
	WOTUG22,
	Dept Computer Science,
	Keele University,
	Keele,
	Staffordshire,
	ST5 5BG,
	UK.

   Payment by CREDIT CARD:

      Card type:  ___ Mastercard/Eurocard   ___ Visa
      (Sorry, no other credit cards can be accepted.)
      Card holder's name:
      Card holder's address:



      Credit card number:
      Expiry date (MM/YY):


   Payment by BANK TRANSFER:

      Payment to be in Sterling, Net of bank charges, to:
      Bank: "National Westminster", 75, High Street, Newcastle, ST5 1PP, UK
      UK bank sort code: 54-10-27
      Account number: 05600456
      Account name: Keele University
      Conference Name: WoTUG22/V3700.0750.100 (please state this clearly)



   Payment by OFFICIAL ORDER / INVOICE:

      Your order number:

      Any other identifying information you would like to appear on the invoice:


      Address you want the invoice sent to, if not your company address above:




Submission

   email this form to kendal@cs.keele.ac.uk
	(note: we do not recommend emailing credit card details)
   OR
   fax this form to +44 1782 713082 (01782 713082)
   OR
   post this form to Kendal Allen, WOTUG22, Dept Computer Science,
       Keele University, Keele, Staffordshire, ST5 5BG, UK.

   Registration will confirmed by email from the conference secretary.

   Cancellation is possible subject to a fee of 20% if received by March 1st
   1999. After that date, no refunds will be made.  A substitute participant
   can be named at any time.