IAHCP Conferences Registration Form

PLEASE REGISTER BY 25 July 2010 TO TAKE ADVANTAGE OF A LOWER REGISTRATION FEE

Maintaining Challenges in Medical Practice, Family Medicine and Education

PERIOD OF CONFERENCE: 21-24 August 2010

Personal Details

Title:	Mr Mrs Dr Prof Lord
First Name:
Family Name
Address:
Country:
Phone No:
Fax:
E-Mail:

Accompanying Person(s)
Family Name:		First Name:		Title:	Mr Mrs Dr Prof Lord
Family Name:		First Name:		Title:	Mr Mrs Dr Prof Lord
Family Name:		First Name:		Title:	Mr Mrs Dr Prof Lord
(The following prices include conference materials and attendance at sessions, lunches, teas and coffees) Please see programme for details of optional evening entertainment.
AHCP Member:£480.00 until 25 July 2010 after £505.00 AHCP Non-Member:£530.00 until 25 July 2010, after £555.00 AHCP Student Member:£250.00 until 25 July 2010, after £270.00 AHCP Student Non-Member:£280.00 until 25 July 2010, after £300.00 Accompanying Person Adult:£280.00 until 25 July 2010, after £300.00
Food
Conference Dinner: £15.50 Self Service Dinner: £9.40
I sent a cheque/International Money Order (Cheques in Sterling Only and madePayable to IMCS) I sent a bank transfer to AHCP account below. Total Amount payed in sterling/GBP :