3rd International Conference on System Safety Registration Form (PDF 53 KB)

The 3rd Institution of Engineering and Technology International Conference on System Safety 2008 20-22 October 2008: NEC, Birmingham, UK One form per person only (forms may be photocopied) REGISTRATION (Please complete in CAPITALS) Family Name_________________________________ Title (Mr, Mrs, Miss etc) _________ Conditions of Booking Application Forms should be completed and returned to the address below and must be accompanied with the correct payment. Attendance at the event will only be confirmed on receipt of the full payment. First Name___________________________________ Job Title _____________________ Institution of Engineering and Technology Membership No ____________________________ Name of Organisation (for name badge) __________________________________________ Address for Correspondence ___________________________________________________ Forms should be received no later than Monday, 13 October 2008. All participants registering less than one week before the date of the event are advised to bring a copy of their registration form with them. ___________________________________________________________________________ Town/City __________________________________________________________________ Cancellation In the event of cancellation and provided that written notice is received seven days prior to the event, a refund of 50% of the total fee will be made. If no notice of cancellation is received, no refund can be made. The Institution of Engineering and Technology reserves the right to cancel any event. In this case, the full fee will be refunded unless a mutually convenient transfer can be arranged. Details of event changes or cancellations are available by phoning +44 (0)1438 767343 Postcode ____________________________________ Country______________________ Contact Telephone ____________________________ Fax _________________________ Email ______________________________________________________________________ Do you have any dietary or other requirements? ____________________________________ How did you hear about this event? Direct Mail ? Word of Mouth ? Colleague ? Other ?_______________ Name Substitutions are accepted at any time by fax or email. Conference Registration fees include attendance at the sessions, a copy of the digest, morning and afternoon refreshments and lunch each day and attendance at the drinks reception on 21 October 2008. FEES AND CHARGES (Please complete the appropriate box) Fax: +44 (0)1438 765659 Email: eventscs2@theiet.org Tutorial registration includes refreshments and lunch on day of tutorial only Early Bird Rate (On or before 8 Sept 2008) Standard Rate (After 8 Sept 2008) CONFERENCE: 21-22 October 2008 £ p Member £395.00 (+ £69.13 VAT= £464.13) £445.00 (+ £77.88 VAT= £522.88) Non-Member £495.00 (+ £86.63 VAT= £581.63) £545.00 (+ £95.38 VAT= £640.38) Retired/Student ‡ £300.00 (+ £52.50 VAT= £352.50) £350.00 (+ £61.25 VAT= £411.25) AUTHOR: 21-22 October 2008 Member £300.00 (+ £52.50 VAT= £352.50) £350.00 (+ £61.25 VAT= £411.25) Non-Member £300.00 (+ £52.50 VAT= £352.50) £350.00 (+ £61.25 VAT= £411.25) Retired/Student ‡ £300.00 (+ £52.50 VAT= £352.50) £350.00 (+ £61.25 VAT= £411.25) TUTORIALS: 20 October 2008 Member £175.00 (+ £30.63 VAT= £205.63) £225.00 (+ £39.38 VAT= £264.38) Non-Member £175.00 (+ £30.63 VAT= £205.63) £225.00 (+ £39.38 VAT= £264.38) Retired/Student ‡ £175.00 (+ £30.63 VAT= £205.63) £225.00 (+ £39.38 VAT= £264.38) Choose two of the following tutorials, one AM and one PM. Check website for details. AM: Tutorial 1 OR Tutorial 3 PM: Tutorial 2 OR Tutorial 4 Total Supporting organisations Members of supporting organisations who can provide evidence of their affiliation will be admitted at members’ rates. Delegates with Special Needs The Institution of Engineering and Technology aims to offer fully accessible events to all its delegates. Please help us to accommodate any individual needs that you may have by attaching a note to the registration form. We will contact you to discuss this as necessary. Data Protection - The information that you provide to the IET and its associated organisations will be used to ensure we provide you with products and services that best meet your needs. This may include the promotion of specific IET and associated organisations products and services by post and/or electronic means. By providing us with your email address and/or mobile telephone number you agree that we may contact you by electronic means. You can change this preference at any time by visiting www.theiet.org/my. The Institution of Engineering and Technology is not, as a body, responsible for the views or opinions expressed by individual authors or speakers. ‡ All students must have their applications endorsed by their Professor or Head of Department Payment must accompany this registration form. Registration will only be confirmed on receipt of full payment PLEASE NOTE: Payment via Purchase Order is not accepted. Please indicate the method of payment: Cheque ? Credit Card ? BACS ? Cheques should be made payable to “IET” and crossed. UK Institution of Engineering and Technology VAT Reg No: 240-3420-16 Credit Card Visa ? MasterCard ? AMEX ? Switch ? Issue No _____ Valid from ____/____ Card Number The Institution of Engineering and Technology is registered as a Charity in England & Wales (no 211014) and Scotland (no SC038698) Expiry Date M M Y Y CSC (Card Security Code) Last 3/4 digits on signature strip Name of Cardholder PAYMENT DETAILS Complete and return this form to: The Institution of Engineering and Technology Finance Department P O Box 96 Stevenage Herts SG1 2SD, UK Fax: +44 (0)1438 765659 For all enquiries telephone +44 (0)1438 765656 or email eventsa1@theiet.org For office use only : Ref: 12405 F314359/1600 Functional Safety Network Full registered address of Cardholder (if different from above) ___________________________ _________________________________ Postcode ____________________ Bank Transfers (BACS) can be made to Barclays Bank Plc, UK Bank, 1 Churchill Place, London, E14 5HP. Account no: 50480606 Sort code: 20-65-82 IBAN BARC 2065 8250 4806 06GB53 . A copy of the Draft must accompany this form. Delegates must be aware that the Institution is not responsible for any gains or losses as a result of fluctuations in the Exchange rate. 20-22 October 2008: NEC, Birmingham, UK Conditions of Booking