Registration Form

To register please complete and return the attached form. At present we are unable to offer online registration.

Registration Information

Fax to +44 (0) 1865 843958

Or mail completed form to:
Amy Hill, FDSM VI Conference Secretariat, Elsevier, The Boulevard, Langford Lane, Kidlington, Oxford, OX5 1GB, UK

Please register me for Fatigue Damage 2008

Delegate Details

Title:

Family name:

First name:

Job title:

Organization:

Address:

Post/Zip Code:

Country:

Tel:

Fax:

Email:

Where did you hear about this conference?
Promotional code (Found on your conference literature)

Special access or dietary requirements:

Presenters should provide their abstract reference number in order to ensure that their material is included in the final program and abstract book:
Ref:

Registration Rate

Conference delegate US$675
Students US$450
(*Student rate applies for registered undergraduate students and those studying full time towards a post-graduate degree.  This rate is not applicable to post doctoral students or employed researchers.  Student registrations must be accompanied by a signed letter from your head of department attesting to student status)

Please send me information on having a table-top exhibit at the conference

Payment Details

Total payment required US$

Please charge my

Card No:

Expiry Date:

Today's Date:

Name and address of cardholder if different from above:

Name:

Address:

Declaration

(Please note that unsigned forms cannot be accepted)

I have read and agree to abide by the payment and cancellation terms, and I understand that this form confirms my conference booking. I accept that from now on charges will be imposed for cancelled registrations, and that up to the full registration fee will be payable if I am unable to attend the conference for any reason.

 

Signed:_________________________________________________

Date:_____________

Data Protection Notice: The personal information that you provide on this form will be used by Elsevier Limited, [a company registered in England and Wales with company number 1982084, whose registered office is The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK, conferenceinfo@elsevier.com (delegates are reminded not to email credit card information in any circumstances)]  and it’s offices worldwide to process your registration and, with your permission, may be used by us and affiliated and non-affiliated third parties for marketing purposes. We respect your privacy and do not rent, sell or disclose your personal information to any non-affiliated third party without your consent.

By submitting this form, you will be indicating your consent to receiving marketing messages from us unless you have indicated an objection to receiving such messages by ticking the boxes below.

If you do not wish to receive special offers or promotions from us about related products and services please tick the relevant boxes below.
Fax Email Tel Post

If you do wish to receive special offers and promotions from carefully selected third party products and services that we feel may be of interest to you, please tick the appropriate boxes below:
Fax Email Tel Post

Print this form