Registration Form

To register please complete and return the attached form. At present we are unable to offer online registration.

Fax to:+44 (0) 118 971 4801

Or mail completed form to:
Claire Norris, TC4 Conference Secretariat, Carlettdene, Church Hill, Midgham, Berkshire, RG7 5UQ, UK

Please register me for the 5th International Conference on
Fracture of Polymers, Composites and Adhesives

Delegate Details

Title:
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Authors should provide their abstract reference number in order to ensure that their material is included in the final programme and abstract book
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Please do not include my name and affiliation in the list of attendees

Please tick this box if you do wish your email address to be given out to delegates of this conference, in the knowledge that it may be used by them for future 3rd party mailings.

Please send me information on having a table-top exhibit at the conference

Registration Rate

Delegate registration (non-ESIS Member): €1300 + VAT @ 7.6% = €1398.80
Delegate registration (ESIS Member): €1250 + VAT @ 7.6% = €1345.00
Student registration*: €1095 + VAT @ 7.6% = €1178.22
* Postdoctoral Fellows and Graduate Students qualify as trainees. Please provide a supporting email or letter from your PhD supervisor stating that you are 1) a fellow within 5 years of completing their PhD (or equivalent) degree or 2) a student registered in a graduate research degree program.
Please book additional tickets for the Conference Dinner at a cost of €69 + VAT @ 7.6% = €74.24 per ticket (One ticket is included with your conference registration fee.)

Payment Details

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Declaration

(Please note that unsigned forms cannot be accepted)

I have read and agree to abide by the payment and cancellation terms, and I understand that this form confirms my conference booking. I accept that from now on charges will be imposed for cancelled registrations, and that up to the full registration fee will be payable if I am unable to attend the conference for any reason.

Signed:_________________________________________________

Date:_____________

Data Protection Notice: The personal information that you provide on this form will be used by Elsevier Limited, [a company registered in England and Wales with company number 1982084, whose registered office is The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, UK, conferenceinfo@elsevier.com (delegates are reminded not to email credit card information in any circumstances)] and it’s offices worldwide to process your registration and, with your permission, may be used by us and affiliated and non-affiliated third parties for marketing purposes. We respect your privacy and do not rent, sell or disclose your personal information to any non-affiliated third party without your consent.

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