BOR - Conference Registration form

Registration Form
Register before 15 February 2016 for early-bird rate!
Name*
First NameLast Name
Title
Professor, Dr, Ms, Mr, etc.
Institution*
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
E-mail*
Phone Number
Country CodeArea CodePhone Number
Registration and Dinner
prevnext( X )
Telecollaboration conference, full rate €125, plus dinner €35€160.00

Telecollaboration conference, full rate €125, no dinner€125.00

Telecollaboration conference, student rate €75, plus dinner €35€110.00

Telecollaboration conference, student rate €75, no dinner€75.00
Your registration includes a welcome reception on Wednesday 20 April on campus; mid-morning and mid-afternoon refreshments on Thursday and Friday; sandwich lunch on Thursday and Friday; and mid-morning refreshments on Saturday.
The dinner (Friday evening) will comprise a drinks reception with canapés and a hot buffet meal (two courses) with wine, in Café en Seine. DJ / dancing available in the venue following the buffet.
Special dietary requirements? - please specify
When you click Submit, you will be directed to a PayPal page.
Should be Empty:

Registration Form