SIDE 1 (click here for side 2)
ES2002 Cambridge, UK : 10-12 December 2002
PLEASE COMPLETE BOTH SIDES OF THIS FORM
NOTE: PAYMENT MUST ACCOMPANY THIS FORM
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RETURN TO:
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Tel: (+44) 151 794 3698 |
| Prof/Dr/Eur Ing/Mr/Mrs/Miss/Ms (delete as applicable) | |
| FORENAME | SURNAME |
| POSITION/APPOINTMENT | |
| ORGANISATION/COMPANY | |
| POSTAL ADDRESS | |
| POST/ZIP CODE | COUNTRY |
| TELEPHONE | FAX |
| SGES MEMBERSHIP NUMBER | |
| NCAF MEMBERSHIP NUMBER | |
| OTHER ECCAI SOCIETY: NAME AND MEMBERSHIP NUMBER | |
Payment is enclosed by cheque, in pounds sterling, made payable to SGES and drawn on a UK bank
OR Payment is being made by Bank Transfer on ___________________________ (date)
Payment by Credit Card VISA / MASTERCARD
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Expiry Date _________________ Name on Card _________________
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On receipt of payment your form will be numbered, stamped and returned as confirmation of your
place at the Conference.
Note: This will become a formal paid VAT invoice only when a delegate number has been assigned