Last updated: 3rd December 2008

Delegate Registration Form

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Conference date: Friday, 8th May 2009
Delegate rate: £65 including lunch

Please ensure cheques are sent no later than 24th April.

No refund if cancelling after 24th April.

Fields marked * are mandatory

Your details

Title: *

Forename: *

Surname: *

Job title:

Department:

Institution:

Address (1): *

Address (2):

Town/City: *

Postcode: *

Country:

Telephone:

Fax:

Email: *

Your requirements

Any dietary requirements?:

Any additional requirements (e.g. hearing loops, disabled parking)?:

Payment options

Cheque

Credit Card

(via Cashiers Office on +44 (0)1782 294412)

Please note: Cheques should be made payable to 'Staffordshire University'.

Submitting the form

Staffordshire University ensures information is stored and handled in accordance with the Data Protection Act 1998. Please read our Privacy Statement (opens in new browser window).

For payments by cheque, please print out the email confirmation you will receive and send it along with payment/official order to:

Tom Ward/Emma Berndt
Institute for Education Policy Research
Brindley Building
Leek Road
Stoke on Trent
Staffordshire
ST4 2DF
Tel: +44 (0)1782 295731
Email: iepr@staffs.ac.uk

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Professional Development Conference

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