EMMCVPR'99   University of York, York, England, July 26-29, 1999

Payment Details

Please fill out this payment form and fax it to Edwin Hancock on +44 1904 432767 by 30th June 1999.

  • The cost of workshop attendance, meals, proceedings and university accommodation for 26th, 27th, and 28th July is £330
  • The cost of workshop attendance, meals and proceedings (no accommodation) is £200.

    Name: __________________________         Email: __________________________

    Organisation/ University: __________________________

    Total amount due:     £200 / £330

    Cheque:     yes / no
        (cheques must be drawn on a bank in the UK and payment made in sterling)

    Credit/debit card details:

        Cardholder name (Capitals) __________________________

        Address at which card is registered:
         _______________________________________
         _______________________________________
         _______________________________________

        Contact phone number:  __________________________

        Card Type:     MasterCard/Access     Visa     Delta     Switch

        Card number: __________________________         Is this a corporate card?     yes / no

        Expiry date: ___________ Card issue no: ___________

        Amount paid: £sterling _____

        Date: ____________

        Cardholders signature: __________________________

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