Sussex Centre for Cultural Studies & The Centre for Material Digital Culture
BOOKING FORM FOR REGISTRATION
Staging Illusion: Digital and Cultural Fantasy, 8th and 9th December
Please complete and return the following form to [email protected] or Staging Illusion
Conference, Silverstone Building, University of Sussex, Falmer, Brighton, BN1 9RG by 15th
October 2011 (for speakers) or 2nd December (for non-speakers).
1. CONTACT DETAILS
Surname:
First Name:
Title:
Correspondence
Address:
Tel:
Fax:
E-mail:
Affiliation if applicable:
(University/Institution)
www.sussex.ac.uk/sccs
www.sussex.ac.uk/rcmdc
@sccs_ www.staging-illusion.tumblr.com
2. REGISTRATION
The registration fees below include attendance at all sessions, refreshments and lunches.
On the Thursday evening we will be attending a local restaurant to socialise and informally
discuss the day’s proceedings - for more details see the website. Attendance has to be paid in
advance.
Booking Rates
2 day attendance with Thursday evening meal
(Accommodation booked and paid separately. See
website)
2 day attendance without Thursday evening meal
(Accommodation booked and paid separately. See
website)
Full fee
Student
£212.50
£107.50
£190
£85
3. PAYMENT OPTIONS
Name:
Signature:
Please choose one of the following options below by ticking the appropriate box and (where
applicable) inserting the relevant information:
A) I would like to pay by Credit/Debit Card (our preferred payment method):
Card Type
Mastercard/Switch/VISA (please specify)
Name on card:
Billing address:
Card Number
Start
date:
Total amount:
Expiry
date:
£
Issue
number
(Switch):
3 digit security
code*
(Other Cards):
* This is the last three digits on the back of your card. You can send this to the Conference coordinator
separately from this form if you are concerned about data security [[email protected]].
B) I enclose a Cheque in £ sterling made payable to ‘University of Sussex’
C) I enclose an International Money Order (£ Sterling Only) payable to ‘University of Sussex’
4. DIETARY AND OTHER REQUIREMENTS
All meals will include vegetarian options. Tick here if you
are vegetarian or detail more specialised requirements.
Please inform us if you have mobility or sensory
impairments and give details of specific requirements.
5. TECHNICAL REQUIREMENTS (FOR SPEAKERS ONLY)
Do you require any special technical requirements
(power point, internet access or DVD playback are
provided)?
If yes, please expand:
YES
NO