Southern Institute for
Health Informatics

2006 Conference

Health Informatics and the Chronic Conditions

Portsmouth

22nd September 2006

SIHI 2006
Friday 22nd September 2006
Richmond Building
University of Portsmouth
 
Proceedings
Speakers
Infomart
Programme Committee
Venue and directions
SIHI 2006 home page
 

More info:

sihi@port.ac.uk
Tel: (023) 9284 6445

Conference registration

Early bird discount applies to bookings on or before 1st September 2006!

Please use this form to register for the SIHI 2006 conference in Portsmouth on 22nd September 2006. If you prefer, a printable form can be downloaded in MS-Word or PDF format.

In order to encourage as many people as possible to attend, we have kept costs low and offer discounts for groups of attendees from the same organisation registering on the same form, and registering before 1st September.

* indicates a mandatory field

Name of company/organisation:

*

Delegates from that organisation:  

   
Registration submitted before
1st September 2006
Registration submitted on or after
1st September 2006
1 Title: Forename: Lastname: 
Jobtitle: 
@ £85.00
@ £95.00
2 Title:  Forename:  Lastname: 
Jobtitle: 
@ £85.00
@ £95.00
3 Title:  Forename:  Lastname: 
Jobtitle: 
@ £60.00
@ £70.00
4 Title: Forename: Lastname:
Jobtitle: 
@ £60.00
@ £70.00
5 Title: Forename: Lastname:
Jobtitle: 
@ £60.00
@ £70.00
6 Title: Forename: Lastname:
Jobtitle: 
@ £60.00
@ £70.00

Correspondence regarding this registration will be addressed to the first named person above

Please give their contact details:

Contact's full postal address*
Contact's email address:  *
Contact's telephone number:  *
Contact's fax number: 

Payment

There are two payment options. Please select the one you prefer.

cheque Please give me a registration form to print and I will send it to you with a cheque
invoice Please send an invoice to me at the above address for the amount of the registrations specified

By registering, I agree to:

  • my/our details being held on a database for the purposes of conference administration and other activities associated with SIHI
  • my/our name, job affiliation and organisation being included on my/our conference name badge(s) and on a list made available to delegates

It is SIHI policy not to provide mailing lists to third parties. We occasionally send out items that we believe will be of interest to people on our contact list.

Cancellation and substitution. Cancellations notified more than 14 days before the conference will be eligible for a full refund. Otherwise, up to 48 hours before the conference, a cancellation fee of £10 per person will be charged. Cancellations at less than 48 hours notice will incur the full fee. Cancellations must be in writing or by email. Substitutions may be made at any time.

Confirm this registration by email.

In case of problems with this form, please email sihi@port.ac.uk

Last updated