Conference Registration Form Conference: Enabling Lifelong Learning Title Mr.Ms.Dr.Prof.Fr.Sr.Rev. Your Name (required) Your Position (required) Institution (required) Address (required) Your Email (required) Your Telephone Number (required) Any Special Dietary requirements I would like to register for the Upcoming Conference (Conference fee of €65 before or on 2nd December, €80 thereafter, Student fee of €15) (required) Please tick Conference 9th Dec 2016 Are you attending the Conference dinner on the 8th Dec Y/N? (Fee of €25, to be held in the Radisson at 7:30pm) Yes No There are three different options you can choose from to make payment to us. Please tick your preferred option.(required) 1. Invoice - We can invoice you for the Fee in which we would require a PO Number from you. We will e-mail you by return to obtain this. 2. Credit/Laser Card - You can pay by card over the Phone and we will send the receipt to you in the post. If this is your preferred option a member of our team will call you in the coming days. 3. Pay on the Day - You can on the Day of the Conference 9th Dec, please arrive early to do so – Credit Card and Laser card will be accepted at this time.