PARTICIPANT Title: *Mr/Mrs/Ms/Miss   Dr/Prof. (male/female)  *ring/underline

First name: ................................................ Last name: ..............................................................................

Organisation: ..............................................................................................................................................
 

Address: ....................................................................................................................................................

City: .......................................... Country: .......................................... Postal code: ....................................
 

Phone: ......................................... Fax: ................................. E-mail: ........................................................
 

ACCOMPANYING PERSON/S:  *ring/underline

First name: *Mr/Mrs/Ms/Miss .................................... Last name: ................................................................

First name: *Mr/Mrs/Ms/Miss .................................... Last name: ................................................................
 

INTEREST IN SYMPOSIUM TOPICS: *ring/lunderline level of interest

*No/Low/Mid/High  Faunistics, Systematics & Ecology
*No/Low/Mid/High  Whitefly Transmitted Viruses & Epidemiology
*No/Low/Mid/High  Whitefly Natural Enemies
*No/Low/Mid/High  Whitefly Control & Integrated Pest Management
 

SOCIAL PROGRAMME:   *ring/underline  The cost of these events is included in your registration

*YES/NO   Technical & Touristic Excursion   7th October 2004
*YES/NO   Technical & Touristic Excursion Accompanying Person  7th October 2004

*YES/NO   Symposium Gala Dinner Delegate   8th October 2004

*YES/NO   Symposium Gala Dinner Accompanying Person   8th October 2004

Any special requirements, e.g dietary/other: ..................................................................................................
 

Registration Fees: *Euro values are variable according to exchange market rates

NEW extended date: from 31st March 2004 to 31 August 2004;
£250 (approx. 350 *Euros) per delegate   £150 (approx. 200 *Euros) per person - accompanying (non-delegate)

AFTER 1st September 2004   £325 (approx. 450 *Euros) per delegate

AFTER 15th September 2004 (or payment at symposium reception desk)
£350 (approx. 500 *Euros) per delegate   £175 (approx. 250 *Euros) per person (non-delegate).

My total cost is:.................................  Date: ...........................  Signature: ....................................................
 

Payment Option A: Credit Card:  *Amex/ Diners/ Master/ Visa   *ring/underline

Credit card number: ...................................................... Expiry date: .........................................
Name on card: ................................................................................ Signature: ...........................................
 

Payment Option B: Cheque:  Cheques payable to: "John Innes Centre"

Please add the following to the reverse side of the cheque: "The 2nd European Whitefly Symposium 2004"
Net payment must be made out in UK POUNDS STERLING (£UK) and
be drawn on a account from a UK clearing bank. The participant's name must be clearly specified.
 

CONFIRMATION OF PAYMENT: Please allow 7-14 days for comfirmation of registration payment

CANCELLATION POLICY: There is no refund for cancellation after  Wednesday 25th August 2004
 

PLEASE RETURN YOUR COMPLETED FORM TO:

Post mail: Liz Robertson, General Secretariat, Whitefly Symposium, EWSN Office,
John Innes Centre, Norwich Research Park, Colney, Norwich, NR4 7UH, UK.
Fax: +44 (0) 1603 450 031   E-mail: ewsn.organiser@whitefly.org   Telephone: +44 (0) 1603 450 296