e-Poetry 2005 London

 

 

 

Date:               28 September – 1 October 2005

Place:             Birkbeck University of London, Malet Street, WC1E 7HX, London, UK

 

 

Conference Credit Card Payment Form

 

Full Conference Fee                                                 ฃ50

Full Fee concessions*                                                          ฃ25

Individual daily fee                                                                 ฃ20

Individual daily fee concessions*                                        ฃ10

Evening performances                                                         ฃ8/ea

Evening Performances concessions                                  ฃ4/ea

 

*Students & Unemployed

 

Conference fees are waived for presenters of papers/readings and performances.

 

I am paying for (please choose from above)ญญญญญญญญญญญญญญญญญญ______________________________

 

ญญญญญญญญญญญญญญญญญญญญญญญญญญญญญ________________________________________________________________

 

I will pay the amount   ฃ______________________ by credit card

 

  Master/Eurocard    Visa             American Express              Other___________

 

Credit card number     _________/________/________/________

Expiry date                  _______/________

Name of cardholder______________________________________________________

CVC Code*                 _____ _____ _____

*3-figure code on the back of your credit card following the credit card number.

 

Date    _________/________/_________

 

Signature________________________________________________________