Personal Details

Title*

Dr Professor Mr Ms Mrs Miss

First Name*

Family Name*

Institution*

Department*

Address 1*

Address 2

Address 3

Town/City*

State/Province/County

Postal/Zip Code*

Country*

Telephone*
Please inc international code

Fax
Please inc international code

Email*

Confirm Email*

Special Diet
If yes please specify
(eg vegetarian, vegan)

Sex (Male/Female)

Male     Female

Conference Details

Research Interests*
Please provide 5-10 key words

Posters
If submitting a poster abstract please give your poster title

Poster abstract deadline 20 April 2012 please submit your abstract via the Posters page.

Applying for travel grant

Yes     No   

Grant application deadline 16 March 2012 please submit your grant application via the Grants page. Note: if you are applying for a grant, please do not pay your registration fees until after the grant award notification date (30 March 2012). If you are awarded a grant this will include a free registration at the meeting.

Invited speaker/organiser

Yes     No   

Registration Type (£ GB Pound)

Regular    £250 (GB Pound)

Student    £150 (GB Pound)

The above rates include:

• Poster session with reception
• Lunches, and coffee/tea breaks
• Conference dinner and reception at Manchester Museum with access to the museum.

Full name as you would like it to appear on your name badge e.g. Bob Smith

*

Institute as you would like it to appear on your name badge e.g. University of Lancaster

*

How did you find out about this symposium?

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