Lympho

SECTION 1 : DELEGATE

* Mandatory fields

Delegate Title : Other, please specify :

First Name(s) * :

Last Name * :

Organisation :

Position :

Address :

Town/City * :

Postcode :

State/Region/County :

Country * :

Work phone number :

Mobile phone number :

Email address * :
Do you have special requirements (dietary, mobility, others) ? * : Yes No

Mobility requirements (Wheelchair access, Limited mobility,...) - please specify :
Dietary requirements (Vegetarian, Allergies, …) - please specify :
Other requirements - please specify :

Do you plan to bring one or several guests to the Gala Dinner * : Yes No

If yes, Guest(s) details :

First Name(s) :

Last Name :

First Name(s) :

Last Name :

First Name(s) :

Last Name :

SECTION 2 : REGISTRATION TO INTERACTIVE SESSIONS AND SKILLS DEVELOPMENT SESSIONS (BREAKOUT SESSIONS)

The final details of the sessions will be announced approximately 1 month before the Conference and ILF will contact you then for you to chose which sessions you want to attend. (See Draft Programme for more information).

Please note that some of these sessions will have limited access and space allocation will be on a first registered first served basis. We therefore recommend you register as soon as possible.

SECTION 3 : REGISTRATION FEES

All fees are quoted in GB Pounds (£) inclusive of VAT

	Before 31/12/09	Before 28/02/10	After 28/02/10
ILF Conference The fee includes : Tuesday : afternoon break + dinner + choice of 2 breakout sessions + evening lecture. Wednesday : morning and afternoon breaks + lunch + gala dinner + choice of 3 breakout sessions + 2 symposia. Thursday : morning and afternoon breaks + lunch + choice of 2 breakout sessions + 1 symposium + ILF/ICC session.	£270	£300	£350
ILF Conference + Open Space Meeting The fee includes : Monday : morning and afternoon breaks + lunch + dinner. Tuesday, Wednesday and Thursday : Same as ILF Conference Thursday.	£324	£360	£410
Gala dinner guests	£60/guest

SECTION 4 : REGISTRATION & PAYMENT

* Mandatory fields

Registration & Payment Date : 07/09/2010 06:09
I want to register for * :
ILF Conference only (March 23-25, 2010)
ILF Conference + Open Space meeting (March 22-25, 2010)
I want to invite * : guest(s) at the gala dinner
Total amount to be paid : £ 350
Payment method *:
PayPal - Please click on following link and follow the instructions.
Bank draft or cheque

Bank transfers :
Bank : Barclays Bank PLC, 75 King Street, Hammersmith, London, W6 9HW
Account name : Centre for Research & Implementation of Clinical Practice
Sort Code : 20-35-90
Account No : 30385492
SWIFTBIC No : BARCGB22
IBAN Nos : GB67 BARC 2035 9030 3854 92

Cheques :
Made payable to Centre for Research & Implementation of Clinical Practice
Sent to : ILF, St Luke's Crypt, Sydney Street, London, SW3 6NH, UK

Payment must accompany your registration form. Conference registration cannot be confirmed until payment is received.

Cancellations

Registration cancellations received before 31/12/09 will receive a full refund, less a £30 administration charge.
Registration cancellations received between 31/12/09 and 14/02/10 will receive a 50% refund.
No refunds will be given for registration cancellations received after 14/02/10

International Lymphoedema Framework

Registration form

2010 ILF Conference - Brighton Centre, March 22-25, 2010

SECTION 1 : DELEGATE

SECTION 2 : REGISTRATION TO INTERACTIVE SESSIONS AND SKILLS DEVELOPMENT SESSIONS (BREAKOUT SESSIONS)

SECTION 3 : REGISTRATION FEES

SECTION 4 : REGISTRATION & PAYMENT

Cancellations