The CCP4 Study Weekend
University of Leeds
3-5 January 2004
 Registration Form

Please note that the closing date for registrations is 8th December 2003.

REGISTRANT'S DETAILS

Please note that fields marked with a '*' must be filled in.
Title  (Prof/Dr/Mr/Mrs/Ms etc)
Forename(s):  *
Surname (family name) :  *
Please enter your forenames and surname as you would like them to appear on your delegate badge.
Nationality:
Gender (for accommodation grouping): Male Female
Address: *(University, company etc.)
  * (Use this address line for your department, if any)
 
 
 
 
Post code: 
Country: 
Telephone:  *
Fax: 
E-mail address: *

Please tick below if you are
Speaker at this event
Member of WG1 Group
Member of PX Users' Group

REGISTRATION FEE

There will be a fee of £80.00 excluding accommodation charges.

ACCOMMODATION

Please indicate the nights you wish to stay. If you would like to arrange a longer stay, please note this in the Special Requirements section.

I will require accommodation for the nights of:

Friday 2nd January
Saturday 3rd January
Sunday 4th January
Monday 5th January
 Please indicate choice of accommodation below (charges include breakfast and all taxes).
Type Charge per night  Please select  
Standard £25.00
En-suite £50.00
Double/twin £70.00

SPECIAL REQUIREMENTS (e.g. special diet, disability etc.)


SPONSORSHIP

Bursary - CCP4 funding is available for students only. For the purpose of the meeting, a bursary will be the cost of registration and one night's standard accommodation (£105.00 in total). If you would like to apply for a bursary please fill in the following information:

I wish to apply for CCP4 funding : Yes No  Age:

Travel assistance - In addition, limited funds will be made available to help pay travel costs for students from European (non-UK) laboratories. In order to be considered for this, please send a letter to Maeri Howard Eales, SBL 5, Daresbury Laboratory, Warrington, WA4 4AD, UK which states your expected cost of travel (most economic means possible) in sterling and signed by your supervisor.

All applicants for sponsorship will receive their notification the week of 17th November 2003.

PAYMENT DETAILS

You will receive a confimation letter, outlining any outstanding amount owed (excluding bursary if applicable) within fifteen working days of sending this form. If you do not, please contact ccp4conf@dl.ac.uk.

If you would like to pay by cheque, please make it payable to CCLRC Daresbury Laboratory and send it to: CCP4, SBL5, Daresbury Laboratory Warrington WA4 4AD, UK. PAYMENT MUST BE IN STERLING.

If you would like to pay by credit card, please click here.

Upon submitting your registration, you should receive an e-mail confirmation of all the details provided. If you do not receive a confirmation or would like to query the information on the form, please contact ccp4conf@dl.ac.uk

By registering to attend the CCP4 Study Weekend 2004, you are responsible for the full financial settlement of your costs. In the event of late cancellation or non-attendance, a participant registered to attend will be liable for the full charge whether or not a bursary was awarded.