Computational Modelling '19 - Registration Form

Please print this form, fill it in, scan it and then email to Jon Wills (jon@min-eng.com) or post to 1 Freeman Collins Drive, Trescobeas Road, Falmouth, Cornwall, TR11 2GA, UK

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Name:
Title (Prof., Dr., etc.):
Name to appear on delegate badge:
Organisation:
Address:
City
Postcode/Zip:     Country:
Telephone:
Email:

Please register me as follows:
Non-author (£495):
Author (£425):
Student* (£315):

Total Payment:

If you wish to pay by bank transfer, tick here and Jon will email you with the details
If you wish to pay by credit card , please supply the following details:

Type of Credit Card:

VISA:   Mastercard:  
Number: Signiture Panel Code
3 Digit Signature Panel Code:
Expiry Date:
Signature:

Cancellations
Cancellations received before 7 April 2019 will be subject to an administration charge of £75. Refunds cannot be made to those who cancel after this date. Substitutions may be made at any time.

*Student registration should be accompanied by certification from Head of Department