| MS /
MR / DR / PROF + Name |
|
Address
|
| Email |
| Telephone |
| I wish to book a place at the
"Recording Leisure Lives" Conference on 30th March,
2010, at Bolton Museum. |
| Signed
Date |
| FEE --
Please tick one option below (both options include lunch) |
 |
£35 |
 |
£20 CONCESSIONS student non waged |
| Special Dietary Requirement,
Please state: |
| Method of Payment Please tick chosen option |
 |
CHEQUE (attached) made payable
to The University of Bolton |
 |
INVOICE: Official Purchase Order
must be attached to this form |
 |
Credit/Debit Card Payment |
| |
Please debit my: Mastercard,
Visa, Maestro (Switch), Electron & Solo (delete as applicable) |
| Card Number: |
| Expiry Date: Security No. (last
3 digits on the back of the card): |
| Valid From: |
| Switch Issue No. (if applicable): |
| Signature: |
|
OFFICE ONLY: Authorisation Code(cardholder
not present): |
Please contact us for details on local accommodation
Email: r.snape@bolton.ac.uk Tel:
01204 903 609 Fax: 01204 903 650 |