Moss 2005

Registration for Accompanying Persons

Family Name:
Given Name : Title:

Preferred names for badge:

Country:

Email:

Telephone:

Accompanying:

Special food (vegetarian/vegan/other (please give details)

Dinner choice Sunday:

salmon
chicken
goulash

Excursion Tuesday? YES NO

Payment (104 Euro for conference plus 52 Euro for the optional excursion) should be made by credit card. Please make sure and print the credit card payment form and submit it by fax to the number located on the form. The form can be downloaded anytime from the main webpage.
If payment by credit card present difficulties, please contact David Cove d.j.cove@leeds.ac.uk.