Thursday 1 March 2007 – Deadline for ‘Early Bird’ registration
Delegate Details: (* Information is mandatory)
*Full name: Prof / Dr / Mr / Mrs / Ms
*Address:
*City………………………….*Postcode………………………………*Country
*Tel *e-mail
*Current Post ...... Health Education Region*
BCS Member: Yes/No BCS Membership Number*:………………………………….
If registration is being made by an agency or company on behalf of a delegate, please make sure you give full contact details of the delegate as required above.
Registration Fee: BCS members - £100 (inclusive of VAT). Non BCS members - £150 (inclusive of VAT).
Accommodation to be booked by attendee, at their own expense.
Payment Method:
CHEQUE £……………….□ (Please make cheque payable to British Cardiovascular Society)
CREDIT CARD £……………………□ (Please provide your Card details below)
BANK TRANSFER DETAILS £……………………□ (Please arrange transfer to the below account, notifying BCS once the transfer has been processed on courses@)
Name of Account: British Cardiovascular Society, Account No: 26771071, Sort Code: 56 00 31,
IBAN Code: GB46 NWBK 5600 3126 7710 71, Swift: BIC: NWBKGB2L
Credit Card Payment Details
Card Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Switch / Maestro / Visa / MasterCard (please circle)
Valid from _ _ / _ _ Expires end _ _ / _ _ Issue number (Switch/Solo) _ _ Security Code _ _ _
Signature
Cardholder’s name, address and telephone number (if different from above)
Name
Address
Email: Tel:
Please return your completed form to Anna Kassai, BCS Courses, 9 Fitzroy Square, London, W1T 5HW, or email to courses@
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