DELEGATE DETAILS

Title: MR/MRS/MISS/DR/OTHER(please specify)

Name:

Company:

Address:

Postal Code:

Country:

Daytime Telephone Number:

Email:

Fax Number:

Arrival Date:

Departure Date:

Time of Arrival:

Total No. of Nights:

No. of Adults:

ACCOMMODATION

If you have a preference from the allocations please indicate below:

1^st Choice:

2^nd Choice:

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Edinburgh First, University of Edinburgh Halls of Residence (Pollock Halls)

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Hotel Ibis

Please indicate your price range

Minimum per person per night £

Maximum per person per night £

TYPE & NUMBER OF ROOMS REQUIRED

Single:

Double:

Twin:

En-Suite Room: YES / NO

Non Smoking Room: YES / NO

Parking Required: YES / NO

CREDIT CARD PAYMENT

IMPORTANT : Your credit card number is required to secure the rooms. Payment should be made directly with the hotel or guest house at the time of stay. If you do not have a credit card, please contact the Conference Bureau for further information.

Credit Card Type: VISA/MASTERCARD/AMEX/DINERS/SWITCH (please specify)

(NB: Most Guest Houses do NOT accept AMEX or DINERS)

Expiry Date:

Number on Card:

If using SWITCH - Issue No:

Name on Card:

(If different from above)

If posting or faxing please sign and date below

Signature:

Date: