Registration
	Please complete the following form to submit your registration. First Name Last Name Academic Industry Institute / Company Postal Address E-mail address Phone Number Fax Number Arrival Date Departure Date Special Dietary Requests? Do you wish to bring a guest to the conference dinner? Yes Cost Academic Industry Registration £250 £300 Dinner Guest £30 £30 Payment Payments is only accepted by the following credit cards. Please select one Visa Mastercard Card Number Expiry Date Please remember, submitting this form will send your credit card details by E-mail. If you do not wish to do this then you may print out this form and send it to: Piera Brambilla HEP Group Physics Department Imperial College London SW7 2BZ United Kingdom Phone + 44 171 594 7824 Fax + 44 171 823 8830
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