Application form

Heritage, Regional Development and Social Cohesion

International conference
Thuesday 22 to Thursday 24 june 2010

Please fill out the application form by closing date of 1 April 2010
(If there are any question, please contact the organisation committee at: pascal@jamtli.com)

1. Delegate details
Title *
First name *
Family name *
Job title *
Organisation *
Daytime tel. *
Fax
E-mail *
I do NOT wish my e-mail address to be made available to other delegates

Invoicing address *

Requirements (Optional)
I will require a hearing loop I will require a signer (indicate type) I will be using a wheelchair
Any additional requirements (please specify)

I have the following dietary requirements

3. Attendance Fee
€350 Full conferance (Including all sessions, lunches and dinners. €315 Early-bird discount (Before 15 march). €290 Companions programme fee.
Total registration fee: €315, 00

2. Companion details

Select number of companions: Change companions

Companion no. 1
First name *
Family name *
E-mail *
Companions programme *

Companion no. 2
First name *
Family name *
E-mail *
Companions programme *