Mr.Mrs.MissMs.Dr.Prof.   Forename:   Surname: 

Workplace(eg. Hospital or Company):        

Department:                                                

Are you a BSSVD Member?                          

Telephone:   Mobile: 

Email Address: 

Please list which nights you wish to stay and which days you are attending, we will invoice accordingly:
Also please add any comments here:

Conference Registration fee includes a conference pack, accommodation where purchased as part of the package, lunch & refreshments. Please go to the Payment page for registration fee details. Payments must accompany the form together with a cheque drawn on any UK Bank in POUNDS STERLING & made payable to BSSVD10.  Alternatively you may pay securely via Paypal by clicking on the Payments page  An administration charge of £50 will be made for cancellations made before October 29th 2010
Any cancellations made after October 30th will be charged in full