Conference Booking Form - RGU Aberdeen

1. 25th-28th June 2013 Robert Gordon University, Aberdeen Conference Booking Form Section 1: Personal Details Title: _______________ Job Title: __________________________________ First Name: ______________________ Organisation: __________________________________ Last Name: ______________________ Address: __________________________________ __________________________________ __________________________________ Telephone: _______________________ __________________________________ Email: _______________________ Postcode: __________________________________ Special Dietary/ Other Requirements : ______________________________________________ _______________________________________________ • Section 2: Registration Details (please tick as appropriate)Full conference (including all conference sessions, lunches and refreshments, early evening reception and conference dinner) •  Early bird rate - £360 (available for booking and payments confirmed before 1st April 2013) •  Full delegate rate - £410 (for bookings after 1st April 2013)  Research student rate - £290 (Please send proof of Student Status) • Accompanying person Conference Dinner - £65 • Day attendance (including all conference sessions, lunch and refreshments, early evening reception for those attending 25th or 26th June; does not include conference dinner): •  Tuesday 25th June - £110 •  Wednesday 26th June - £135 •  Thursday 27th June - £110 •  Friday 28th June - £110 • Optional visits Saturday 29th June: • Balmoral Castle / Royal Lochnagar Distillery - £79 • (Lunch at Balmoral Castle not included) Total payment due: ______________

2. Section 3: Payment Options Please choose one of the following (tick and complete as appropriate):  Cheque (please make payable to The Robert Gordon University) Please note only cheques in GBP and drawn on a UK Bank account can be accepted. No other cheque format will be accepted. Sterling Travellers cheques are acceptable.  Credit Card Name of cardholder : ____________________________________________________ Address of cardholder: ____________________________________________________ ____________________________________________________ Postcode: ___________________ Card type (Visa etc): __________ Card No: ______________________________________ Start date: ___ / ___ Expiry date: ___ / ___ Issue No. (debit cards only): _____ Last 3 digits on security strip (reverse of card): _______ Please debit £ ____________ from the card above.  Bank transfer - see details below. Delegates should quote "Delegate name & IM708 060 i3 Conference" Account Name – The Robert Gordon University Bank name – Bank of Scotland Bank Address – Queens Cross Branch, 39 Albyn Place, Aberdeen AB10 1YN, UK Sort Code – 80-05-14 Account Number – 06003836 IBAN – GB08 BOFS 8005 1406 0038 36 SWIFT/BIC – BOFSGB21353 Confirmation of all bank transfer payments should be sent to cash@rgu.ac.uk to help identification of payee. Please note the bookings cannot be fully confirmed until payment has been received (see Terms and Conditions). All payments must be received by 12th June 2013. I confirm that I have read and understood the Terms and Conditions (available on the i3 Website)  Please return form to: Information: Interactions and Impact (i3), H302, Faculty of Health and Social Care, Robert Gordon University, Garthdee Road, Aberdeen, AB10 7QG, UK. Email: i3information@rgu.ac.uk