Physical Separation '19 - Registration Form

Please print this form, fill it in, scan it and then email to Jon Wills ( or post to 1 Freeman Collins Drive, Trescobeas Road, Falmouth, Cornwall, TR11 2GA, UK

Title (Prof., Dr., etc.):
Name to appear on delegate badge:
Postcode/Zip:     Country:

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:

Cancellations received before 9 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


MEI takes photos and videos at this event. By registering, you give MEI permission to use any images taken during the event in which you appear.

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