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 15 May 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: €350, 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 *