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PhysChem FORUM 11

First name:
Last name:
Affiliation:
E-mail address: (please double-check this to ensure you can be contacted with further details!)
Contact telephone:
I would like to present a poster
I would like to book a room (£135, includes dinner, bed and breakfast)
Dinner rate only please (£30)
I have special dietary requirements (you will be contacted by e-mail for these).

You will be contacted before the event for payment details to confirm your booking. If you would like to discuss a trade stand please contact registration@physchem.org.uk.