Registration Form

Registration Information

To register please complete the following form and print out. At present we are unable to offer online registration.

Fax completed form to: +44 (0) 1865 843958 / 853282

Mail to: Nina Woods, RSTMH Conference Secretariat
Elsevier, The Boulevard, Langford Lane, Kidlington, Oxford Ox5 1GB, UK

Please register me for the RSTMH Centenary Conference

Please tick this box if you do wish your email address to be given out to delegates of this conference, in the knowledge that it may be used by them for future 3rd party mailings.

Poster and oral presenters should provide their abstract reference number in order to ensure that their material is included in the final programme and abstract book:
Ref:

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

Registration Rate

Delegate registration = £475 + VAT @ 17.5% = £558.12

Conference Dinner

One ticket to the conference dinner is included in your registration fee. Additional tickets for partners can be ordered here.

Please send me additional tickets for the Centenary Conference Dinner/Drinks Reception @ £50 + VAT = £58.75

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 and mail or fax this form back to us, or contact us at conferenceinfo@elsevier.com:
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(Delegates are reminded not to email credit card information in any circumstances.)

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:
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