e-Poetry 2005 London

Conference Registration Form

To be completed by all conference attendees

Date: 28 September – 1 October 2005

Place: Birkbeck University of London, Malet Street WC1E 7HX, London, UK

Please save/print and return by e-mail or fax.

Please note that this is how you will be indicated on your badge and the list of participants.

1. Participants Information

Surname:__________________________________________________________________

Title:_____________First name:________________________________________________

Organisation:_______________________________________________________________

Job title: __________________________________________________________________

Address:___________________________________________________________________

__________________________________________________________________________

City:____________________________________ Postal code:________________________

Country:___________________________________________________________________

Telephone:________________________________________________________________

E-mail:____________________________________________________________________

Please check one:

I am attending the full conference as a delegate

I am attending the full conference as a presenter of a paper/reading and/or performance

I am attending a selection of workshops/evening performances (Please describe)

____________________________________________________________________

2. Delegate Conference Fees

Full conference fees include admission to all conference sessions and performances, daily refreshments (morning and afternoon tea/coffee, sandwich lunch), delegates pack and entrance to evening performances.

Payment (credit card) can either be faxed on Conference Payment Form to 44 (0) 7631 6889 (secure fax), or at the point of delegate registration upon arrival at the conference by credit card, cheque (Apologies, British Stirling cheques only) or cash.

Full Conference Fee £50

Full Fee concessions* £25

Individual daily fee £20

Individual daily fee concessions* £10

Evening performances £8/ea

Evening Performances concessions £4/ea

*Students & Unemployed

Conference fees are waived for presenters of papers/readings and performances.

2. Paper/Reading/Performance Requirements

If you are giving a paper, reading or performance, please complete the AV & Room Check List as soon as you can and no later than 26 September 2005. You may not have the audiovisual equipment or appropriate space you need or technical support if this form in not completed.

3. Individual Requirements

If you have dietary or individual requirements, please list details here.

___________________________________________________________________

___________________________________________________________________________

4. Additional Information

You will be sent general information about the conference, an AV & Room Check List, if you are performing or presenting a paper/reading, and a Conference Payment Form. If you have any questions please do not hesitate to contact Marjorie Hoek, see details below. Optional evening dinners and Sunday brunch, paid locally, can be booked once you arrive.

Please return completed Registration Form by email or fax to:

Marjorie Hoek

Business Relations Unit

Birkbeck, University of London

Malet Street

London WC1E 7HX

m.hoek@bbk.ac.uk

Direct Line: 44 (0) 20 7079 0736

Fax: 44 (0) 20 7631 6889