Structural Genomics:
From Gene to Structure to Function
Robinson College, Cambridge
20-22 September 2000

Registration Form


Please print out and send completed form by fax or post
(address details below)

CONTACT INFORMATION
Title:   
Forename:  
Surname:  
Affiliation:  
Category:
(Please delete as appropriate)		 Student     (undergraduate or postgraduate)
Academic (post-doc or faculty)
Industry 
Address:
 
 

 
Post Code:  
Email Address:  
Telephone/Fax:  

PARTICIPATION SELECTIONS
Please select ONLY ONE of Day or Residential.
Type Fee (after 1/8/00) Cost Incurred
Day £120   (student)
£175   (academic)
£280   (industry) 		 £
Residential  £220   (student)
£300   (academic)
£430   (industry) 		 £
    Sub-total A 
£

 
Type Fee Dates
Available		 Dates
Selected		 No. Cost Incurred
Parking £3 per night/day 20/9
21/9
22/9		      
Conference Dinner Ticket 
(NB: this is included in the residential package)		 £30 each 21/9 21/9   £
          Sub-total  B 
£
 

TOTAL DUE
Sub-total A
+
Sub-total B
  

 
If parking required
please indicate the following:		  
   Model of car:  
   Colour:  
   Registration No:  

 
 
Special Diets
please indicate as appropriate		  
   Vegetarian  
   Vegan  
   Kosher  
   Halal
Other (please specify)

 
Other Requirements
please indicate as appropriate:
 
 
 

 
 
PAYMENT
Payment can be made by credit card (Visa or Mastercard) or cheque.
 
  • Please indicate preferred method of payment.  If payment is to be by cheque, please enter cheque number.
    • I wish to pay by credit card.  My credit card details and signature are appended below.  
    I wish to pay by cheque.  I am attaching cheque no. [                               ]  

     
    Credit Card Payments

    *Please indicate which card you wish to use*

    		 Visa 
    		Master
    Card
    Card number:  
    Expiry date (eg 11/00):  
    Name (as shown on card):  
    Signature:   

    All credit card transactions will be processed in £ sterling and are subject to current exchange rates.
     
     
    Payment by Cheque
    Cheques should be in £ sterling and drawn on a UK bank.

    Please make cheques payable to "Molecular Graphics and Modelling Society"

    Please enter cheque number above, and write registrant name on the back of the cheque.

     
     
    Address for Return of Registration Forms

    Please send completed form (hard copy only), together with cheque, or credit card details.

    		 Evelyn Boyle
    Bioinformatics
    SmithKline Beecham Pharmaceuticals R&D
    New Frontiers Science Park
    Third Avenue
    Harlow
    Essex  CM19 5AW

    Fax (in UK):                   01279 622200
    Fax (outside UK):   +44 1279 622200

    If you would like further advice or assistance, contact Evelyn Boyle: evelyn_boyle-1@sbphrd.com

    Home Page
    Back to Top